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Matsuda S, Kotani T, Okazaki A, Nishioka D, Watanabe R, Gon T, Manabe A, Shoji M, Kadoba K, Hiwa R, Yamamoto W, Hashimoto M, Takeuchi T. Prediction model for respiratory-related mortality in microscopic polyangiitis with interstitial lung disease: multicentre REVEAL cohort study. Rheumatology (Oxford) 2024; 63:1607-1615. [PMID: 37632776 DOI: 10.1093/rheumatology/kead444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/11/2023] [Accepted: 07/28/2023] [Indexed: 08/28/2023] Open
Abstract
OBJECTIVE This study aimed to establish prediction models for respiratory-related mortality in microscopic polyangiitis (MPA) complicated by interstitial lung disease (ILD) using clinical characteristics. METHODS We enrolled patients with MPA with ILD between May 2005 and June 2021 in a multicentre cohort of Japanese patients with MPA (REVEAL cohort). We evaluated the demographic, clinical, laboratory, radiological findings, treatments and the presence of honeycombing 1 cm above the diaphragm using chest high-resolution CT (HRCT) on admission. We explored the risk factors predictive of respiratory-related mortality. RESULTS Of 115 patients, 26 cases died of respiratory-related diseases during a median follow-up of 3.8 years. Eighteen patients (69%) died due to respiratory infection, three (12%) had diffuse alveolar haemorrhage, and five (19%) had exacerbation of ILD. In univariate analysis, older age, lower percent forced vital capacity (%FVC), lower percent diffusing capacity of carbon monoxide (%DLCO), and the presence of honeycombing in the right lower lobe were identified as risk factors. Additionally, in multivariate analysis adjusted for age and treatment, %FVC, %DLCO and the presence of honeycombing in the right lower lobe were independently associated with respiratory-related mortality. We created prediction models based on the values of %FVC, %DLCO and presence of honeycombing on chest HRCT (termed "MPF model"). The 5-year respiratory-related death-free rate was significantly different between patients with MPA with ILD stratified by the number of risk factors based on the MPF model. CONCLUSIONS Our study indicates that the MPF model may help predict respiratory-related death in patients with MPA with ILD.
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Affiliation(s)
- Shogo Matsuda
- Department of Internal Medicine IV, Division of Rheumatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Takuya Kotani
- Department of Internal Medicine IV, Division of Rheumatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ayana Okazaki
- Department of Internal Medicine IV, Division of Rheumatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Daisuke Nishioka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University, Osaka, Japan
| | - Takaho Gon
- Department of Clinical Immunology, Osaka Metropolitan University, Osaka, Japan
| | - Atsushi Manabe
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mikihito Shoji
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keiichiro Kadoba
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Hiwa
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Okayama, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka Metropolitan University, Osaka, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine IV, Division of Rheumatology, Osaka Medical and Pharmaceutical University, Osaka, Japan
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Jia J, Meng D, Zhang X, Lai N, Zhou B, Wei H, Li X. Clinical application of blood purification in polymyositis/dermatomyositis. Ther Apher Dial 2024; 28:112-118. [PMID: 37853934 DOI: 10.1111/1744-9987.14072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/30/2023] [Accepted: 09/30/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION We investigated the clinical efficacy and safety of blood purification technology in patients with polymyositis/dermatomyositis. METHODS In a study of 22 patients, 10 cases received blood purification treatment (5 cases received plasma exchange, 5 cases received plasma HA280 immunoadsorption), and 12 cases served as the control group. A 3-month follow-up was conducted to compare the clinical manifestations and laboratory examination. RESULTS Symptoms and signs of patients in treatment group were significantly improved, and the hormone usage was lower than the control group. For patients with normal creatine kinase level and ferritin level below three times the upper limit of normal, there was a positive correlation between their N/L values and MDAAT scores. CONCLUSION The results of this study suggest that blood purification therapy, including plasma HA280 immunoadsorption and plasma exchange, is an effective and safe treatment for patients with polymyositis/dermatomyositis, offering assistance in reducing hormone usage in the long-term.
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Affiliation(s)
- Jieting Jia
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Defang Meng
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xuexiang Zhang
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Nalin Lai
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Beibei Zhou
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Hua Wei
- Department of Rheumatology, Clinical Medical College, Yangzhou University, Yangzhou, China
| | - Xiaocong Li
- Department of Neurology, The Affiliated Hospital of Yangzhou University, Yangzhou University, Yangzhou, China
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Wang H, Wang Y, Sun D, Yu S, Du X, Ye Q. Progressive pulmonary fibrosis in myositis-specific antibody-positive interstitial pneumonia: a retrospective cohort study. Front Med (Lausanne) 2024; 10:1325082. [PMID: 38274458 PMCID: PMC10808296 DOI: 10.3389/fmed.2023.1325082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/30/2023] [Indexed: 01/27/2024] Open
Abstract
Objectives Idiopathic inflammatory myopathy (IIM) frequently coexists with interstitial pneumonia (IP) and is commonly the initial or sole manifestation accompanied by positive myositis-specific autoantibodies (MSAs), even in the absence of meeting diagnostic criteria. This study aims to evaluate the proportion of progressive pulmonary fibrosis (PPF) and identify potential predictors influencing the progression of pulmonary fibrosis in patients with MSA-IP. Methods This descriptive study employed a retrospective cohort design, enrolling patients diagnosed with interstitial pneumonia and positive MSAs at Beijing Chao-Yang Hospital in a sequential manner. Clinical data were systematically collected from the patients' medical records during regular follow-up visits conducted every 3 to 6 months. Cox regression analysis was utilized to identify independent predictors of PPF in patients with positive MSAs and interstitial pneumonia. Results A total of 307 patients were included in the study, with 30.6% of them developing PPF during a median follow-up period of 22 months. Kaplan-Meier survival curves demonstrated a significantly lower survival in the PPF patients compared to the non-PPF patients (median 11.6 months vs. 31 months, p = 0.000). An acute/subacute onset of interstitial pneumonia (HR 3.231, 95%CI 1.936-5.392, p = 0.000), lower diffusing capacity of the lungs for carbon monoxide (DLCO) % predicted (HR 6.435, 95%CI 4.072-10.017, p = 0.001), and the presence of diffuse alveolar damage (DAD) on high-resolution computed tomography (HRCT) (HR 8.679, 95%CI 1.974-38.157, p = 0.004) emerged as independent predictors of PPF. Notably, the implementation of triple therapy comprising glucocorticoids, immunosuppressants, and antifibrotic drugs was associated with a reduced risk of developing PPF (HR 0.322, 95%CI 0.115-0.899, p = 0.031). Conclusion Approximately 30.6% of patients with MSA-IP may develop PPF within the follow-up period. Patients presenting with an acute/subacute onset of interstitial pneumonia, lower predicted DLCO SB% and evidence of DAD on HRCT are more susceptible to developing PPF. Conversely, the administration of triple therapy appears to serve as a protective factor against the development of PPF in patients with MSA-IP.
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Affiliation(s)
- Huijuan Wang
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yuanying Wang
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Di Sun
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Shiwen Yu
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xuqin Du
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qiao Ye
- Clinical Center for Interstitial Lung Diseases, Beijing Institute of Respiratory Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
- Department of Occupational Medicine and Toxicology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Kotani T, Matsuda S, Okazaki A, Nishioka D, Watanabe R, Gon T, Manabe A, Shoji M, Kadoba K, Hiwa R, Yamamoto W, Hashimoto M, Takeuchi T. Risk prediction model for mortality in microscopic polyangiitis: multicentre REVEAL cohort study. Arthritis Res Ther 2023; 25:223. [PMID: 37986108 PMCID: PMC10658814 DOI: 10.1186/s13075-023-03210-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 11/07/2023] [Indexed: 11/22/2023] Open
Abstract
BACKGROUND To establish refined risk prediction models for mortality in patients with microscopic polyangiitis (MPA) by using comprehensive clinical characteristics. METHODS Data from the multicentre Japanese registry of patients with vasculitis (REVEAL cohort) were used in our analysis. In total, 194 patients with newly diagnosed MPA were included, and baseline demographic, clinical, laboratory, and treatment details were collected. Univariate and multivariate analyses were conducted to identify the significant risk factors predictive of mortality. RESULTS Over a median follow-up of 202.5 (84-352) weeks, 60 (30.9%) of 194 patients died. The causes of death included MPA-related vasculitis (18.3%), infection (50.0%), and others (31.7%). Deceased patients were older (median age 76.2 years) than survivors (72.3 years) (P < 0.0001). The death group had shorter observation periods (median 128.5 [35.3-248] weeks) than the survivor group (229 [112-392] weeks). Compared to survivors, the death group exhibited a higher smoking index, lower serum albumin levels, higher serum C-reactive protein levels, higher Birmingham Vasculitis Activity Score (BVAS), higher Five-Factor Score, and a more severe European Vasculitis Study Group (EUVAS) categorization system. Multivariate analysis revealed that higher BVAS and severe EUVAS independently predicted mortality. Kaplan-Meier survival curves demonstrated lower survival rates for BVAS ≥20 and severe EUVAS, and a risk prediction model (RPM) based on these stratified patients into low, moderate, and high-risk mortality groups. CONCLUSIONS The developed RPM is promising to predict mortality in patients with MPA and provides clinicians with a valuable tool for risk assessment and informed clinical decision-making.
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Affiliation(s)
- Takuya Kotani
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Daigaku-Machi 2-7, Takatsuki, Osaka, 569-8686, Japan.
| | - Shogo Matsuda
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Daigaku-Machi 2-7, Takatsuki, Osaka, 569-8686, Japan
| | - Ayana Okazaki
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Daigaku-Machi 2-7, Takatsuki, Osaka, 569-8686, Japan
| | - Daisuke Nishioka
- Department of Medical Statistics, Research & Development Center, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Ryu Watanabe
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takaho Gon
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Manabe
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Mikihito Shoji
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Keiichiro Kadoba
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ryosuke Hiwa
- Department of Rheumatology and Clinical Immunology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Wataru Yamamoto
- Department of Health Information Management, Kurashiki Sweet Hospital, Kurashiki, Japan
| | - Motomu Hashimoto
- Department of Clinical Immunology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tohru Takeuchi
- Department of Internal Medicine (IV), Division of Rheumatology, Osaka Medical and Pharmaceutical University, Daigaku-Machi 2-7, Takatsuki, Osaka, 569-8686, Japan
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Yeo J, Yoon SH, Kim JY, Lee JS, Lee EY, Goo JM, Pourzand L, Goldin JG, Kim GJ, Ha Y. Quantitative interstitial lung disease scores in idiopathic inflammatory myopathies: longitudinal changes and clinical implications. Rheumatology (Oxford) 2023; 62:3690-3699. [PMID: 36929924 PMCID: PMC10629794 DOI: 10.1093/rheumatology/kead122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 02/01/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVES To investigate computer-aided quantitative scores from high-resolution CT (HRCT) images and determine their longitudinal changes and clinical significance in patients with idiopathic inflammatory myopathies (IIMs)-related interstitial lung disease (IIMs-ILD). METHODS The clinical data and HRCT images of 80 patients with IIMs who underwent serial HRCT scans at least twice were retrospectively analysed. Quantitative ILD (QILD) scores (%) were calculated as the sum of the extent of lung fibrosis, ground-glass opacity, and honeycombing. The individual time-estimated ΔQILD between two consecutive scans was derived using a linear approximation of yearly changes. RESULTS The baseline median QILD (interquartile range) scores in the whole lung were 28.1% (19.1-43.8). The QILD was significantly correlated with forced vital capacity (r = -0.349, P = 0.002) and diffusing capacity for carbon monoxide (r = -0.381, P = 0.001). For ΔQILD between the first two scans, according to the visual ILD subtype, QILD aggravation was more frequent in patients with usual interstitial pneumonia (UIP) than non-UIP (80.0% vs 44.4%, P = 0.013). Multivariable logistic regression analyses identified UIP was significantly related to radiographic ILD progression (ΔQILD >2%, P = 0.015). Patients with higher baseline QILD scores (>28.1%) had a higher risk of lung transplantation or death (P = 0.015). In the analysis of three serial HRCT scans (n = 41), dynamic ΔQILD with four distinct patterns (improving, worsening, convex and concave) was observed. CONCLUSION QILD changes in IIMs-ILD were dynamic, and baseline UIP patterns seemed to be related to a longitudinal progression in QILD. These may be potential imaging biomarkers for lung function, changes in ILD severity and prognosis in IIMs-ILD.
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Affiliation(s)
- Jina Yeo
- Division of Rheumatology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, Republic of Korea
| | - Soon Ho Yoon
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ju Yeon Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Seok Lee
- Clinic Pappalardo Center, Korea Advanced Institute of Science and Technology (KAIST), Daejeon, Republic of Korea
- GENOME INSIGHT Inc, Daejeon, Republic of Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jin Mo Goo
- Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Lila Pourzand
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Jonathan G Goldin
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Grace‐Hyun J Kim
- Department of Radiological Sciences, David-Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - You‐Jung Ha
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi‐Do, Republic of Korea
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Ren FP, Chen Q, Yao SS, Feng L, Xue XY, Zhao WC, Wang D, Zhao ZL, Gu SW, Li T, Shen YW, Gao L, Zang XL, Bao XY, Tong ZH. Characteristics and prognostic implications of peripheral blood lymphocyte subsets in patients with anti-MDA5 antibody positive dermatomyositis-interstitial lung disease. BMC Pulm Med 2023; 23:411. [PMID: 37898737 PMCID: PMC10612305 DOI: 10.1186/s12890-023-02706-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 10/11/2023] [Indexed: 10/30/2023] Open
Abstract
OBJECTIVES To examine the characteristics of blood lymphocyte subsets in dermatomyositis-interstitial lung disease (DM-ILD) inflicted patients with positive anti-melanoma differentiation-associated gene 5 (anti-MDA5), as well as its prognosis value in this set of patients. METHODS Data were retrospectively collected from 253 DM-ILD patients from three hospitals in China between January 2016 to January 2021. Patients were grouped into anti-MDA5 antibody positive group (MDA5+ DM-ILD) and anti-MDA5 antibody negative group (MDA5- DM-ILD) based on myositis-specific autoantibody test results. Demographic characteristics, lymphocyte subsets patterns and other clinical features were compared between the two groups. The association of lymphocyte subsets with 180-day mortality was investigated using survival analysis in MDA5+ DM-ILD. RESULTS Out of 253 eligible patients with DM-ILD, 59 patients were anti-MDA5+ and 194 were anti-MDA5-. Peripheral blood lymphocyte count, CD3+ count, percentage of CD3+, CD3+CD4+ count, and CD3+CD8+ count was lower in MDA5+ DM-ILD than in MDA5- DM-ILD- (all P < 0.001) as well as CD3-CD19+ count (P = 0.04). In MDA5+ DM-ILD, CD3+CD8+ count ≤ 49.22 cell/μL (HR = 3.81, 95%CI [1.20,12.14]) and CD3-CD19+ count ≤ 137.64 cell/μL (HR = 3.43, 95%CI [1.15,10.24]) were independent predictors of mortality. CD3+CD8+ count ≤ 31.38 cell/μL was associated with a higher mortality risk in all DM-ILD patients (HR = 8.6, 95%CI [2.12,31.44]) after adjusting for anti-MDA5 and other clinical characteristics. CONCLUSION Significant lymphocytes decrease was observed in MDA5+ DM-ILD patients. CD3+CD8+ cell count was associated with worse prognosis in both MDA5+ DM-ILD and all DM-ILD patients.
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Affiliation(s)
- Fang-Ping Ren
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Qi Chen
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | | | - Lin Feng
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Xin-Ying Xue
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Wei-Chao Zhao
- PLA Strategic Support Force Medical Center, Beijing, China
| | - Dong Wang
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Zhi-Ling Zhao
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Si-Wei Gu
- Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Ting Li
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ya-Wen Shen
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Lan Gao
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Xue-Lei Zang
- Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | | | - Zhao-Hui Tong
- Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China.
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Abe K, Furuta S, Kobayashi Y, Sugiyama T, Kagami SI, Nakagomi D, Iwamoto T, Ikeda K, Nakajima H. Prognosis of spontaneous pneumomediastinum occurring in dermatomyositis or polymyositis patients with interstitial lung disease according to antimelanoma differentiation-associated gene 5 antibody status: a retrospective cohort study. RMD Open 2023; 9:rmdopen-2022-002770. [PMID: 36759007 PMCID: PMC9923350 DOI: 10.1136/rmdopen-2022-002770] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
OBJECTIVES Spontaneous pneumomediastinum (SPNM) historically has been considered a poor prognostic factor in dermatomyositis/polymyositis patients complicated with interstitial lung disease (ILD). However, there is a lack of actual data regarding the association between SPNM occurrence and mortality in dermatomyositis/polymyositis patients. This study aimed to assess the association between SPNM occurrence and mortality in myositis patients with ILD according to antimelanoma differentiation-associated gene 5 (MDA5) antibody status. METHODS Dermatomyositis/polymyositis patients with ILD who were hospitalised at five Japanese hospitals from 2016 to 2020 were included in this retrospective observational study. We collected data about baseline characteristics including myositis-specific autoantibodies, treatments, SPNM and death within 1 year from therapy initiation or strengthening. Baseline characteristics and outcomes were compared between patients with and without SPNM (the SPNM group and the non-SPNM group, respectively). RESULTS A total of 119 patients were analysed. SPNM occurred in 23 patients, and 15 patients died. Fifteen patients with SPNM were anti-MDA5 antibody positive. The mortality rate was significantly higher in the SPNM group (34.8%) than in the non-SPNM group (7.3%) (p=0.001). All deaths in the SPNM group occurred in anti-MDA5 antibody-positive patients (8/15), whereas none of the anti-MDA5 antibody-negative patients in the SPNM group died (0/8). In anti-MDA5 antibody-positive patients, the mortality rate was significantly higher in patients with SPNM occurrence (53.3%) than in those without SPNM occurrence (4.0%) (p=0.001). CONCLUSION SPNM occurred more frequently in anti-MDA5 antibody-positive than in anti-MDA5 antibody-negative myositis patients. SPNM occurrence was associated with higher mortality risk, especially in anti-MDA5 antibody-positive patients.
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Affiliation(s)
- Kazuya Abe
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Shunsuke Furuta
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Yoshihisa Kobayashi
- Department of Internal Medicine, Chiba Aoba Municipal Hospital, Chiba, Japan
| | - Takao Sugiyama
- Department of Rheumatology, National Hospital Organization Shimoshizu Hospital, Yotsukaido, Chiba, Japan
| | - Shin-Ichiro Kagami
- Research Center for Allergy and Clinical Immunology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Daiki Nakagomi
- Third Department of Internal Medicine, University of Yamanashi Hospital, Chuo, Japan
| | - Taro Iwamoto
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Kei Ikeda
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
| | - Hiroshi Nakajima
- Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan
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Enomoto N. Pathological Roles of Pulmonary Cells in Acute Lung Injury: Lessons from Clinical Practice. Int J Mol Sci 2022; 23:ijms232315027. [PMID: 36499351 PMCID: PMC9736972 DOI: 10.3390/ijms232315027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/23/2022] [Accepted: 11/26/2022] [Indexed: 12/05/2022] Open
Abstract
Interstitial lung diseases (ILD) are relatively rare and sometimes become life threatening. In particular, rapidly progressive ILD, which frequently presents as acute lung injury (ALI) on lung histopathology, shows poor prognosis if proper and immediate treatments are not initiated. These devastating conditions include acute exacerbation of idiopathic pulmonary fibrosis (AE-IPF), clinically amyopathic dermatomyositis (CADM), epidermal growth factor receptor-tyrosine kinase inhibitor (EGFR-TKI)-induced lung injury, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) infection named coronavirus disease 2019 (COVID-19). In this review, clinical information, physical findings, laboratory examinations, and findings on lung high-resolution computed tomography and lung histopathology are presented, focusing on majorly damaged cells in each disease. Furthermore, treatments that should be immediately initiated in clinical practice for each disease are illustrated to save patients with these diseases.
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Affiliation(s)
- Noriyuki Enomoto
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan; ; Tel.: +81-53-435-2263; Fax: +81-53-435-2354
- Health Administration Center, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan
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Clinical and Radiological Features of Interstitial Lung Diseases Associated with Polymyositis and Dermatomyositis. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58121757. [PMID: 36556960 PMCID: PMC9784142 DOI: 10.3390/medicina58121757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Revised: 11/17/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022]
Abstract
Polymyositis and dermatomyositis are autoimmune idiopathic systemic inflammatory diseases, characterized by various degrees of muscle inflammation and typical cutaneous lesions-the latter found in dermatomyositis. The underlying pathogenesis is characterized by a high level of uncertainty, and recent studies suggest diseases may have different immunopathological mechanisms. In polymyositis, components of the cellular immune system are involved, whereas in dermatomyositis, the pathogenesis is mainly mediated by the humoral immune response. The interstitial lung disease occurs in one-third of polymyositis and dermatomyositis patients associated with worse outcomes, showing an estimated excess mortality rate of around 40%. Lung involvement may also appear, such as a complication of muscle weakness, mainly represented by aspiration pneumonia or respiratory insufficiency. The clinical picture is characterized, in most cases, by progressive dyspnea and non-productive cough. In some cases, hemoptysis and chest pain are found. Onset can be acute, sub-acute, or chronic. Pulmonary involvement could be assessed by High Resolution Computed Tomography (HRCT), which may identify early manifestations of diseases. Moreover, Computed Tomography (CT) appearances can be highly variable depending on the positivity of myositis-specific autoantibodies. The most common pathological patterns include fibrotic and cellular nonspecific interstitial pneumonia or organizing pneumonia; major findings observed on HRCT images are represented by consolidations, ground-glass opacities, and reticulations. Other findings include honeycombing, subpleural bands, and traction bronchiectasis. In patients having Anti-ARS Abs, HRCT features may develop with consolidations, ground glass opacities (GGOs), and reticular opacities in the peripheral portions; nonspecific interstitial pneumonia or nonspecific interstitial pneumonia mixed with organizing pneumonia have been reported as the most frequently encountered patterns. In patients with anti-MDA5 Abs, mixed or unclassifiable patterns are frequently observed at imaging. HRCT is a sensitive method that allows one not only to identify disease, but also to monitor the effectiveness of treatment and detect disease progression and/or complications; however, radiological findings are not specific. Therefore, aim of this pictorial essay is to describe clinical and radiological features of interstitial lung diseases associated with polymyositis and dermatomyositis, emphasizing the concept that gold standard for diagnosis and classification-should be based on a multidisciplinary approach.
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Predictors of progression in idiopathic inflammatory myopathies with interstitial lung disease. J Transl Int Med 2022. [PMID: 37533847 PMCID: PMC10393057 DOI: 10.2478/jtim-2022-0029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract
The idiopathic inflammatory myopathies (IIMs) are a group of connective tissue diseases that afect multiple organ systems, including the lungs. Interstitial lung disease (ILD) is the most common and heterogeneous complication of IIMs, with its degree ranging from mild to fatal. Thus, it is critical to identify clinical features and validated biomarkers for predicting disease progression and prognosis, which could be beneficial for therapy adjustment. In this review, we discuss predictors for rapid progression of IIM-ILD and propose guidance for disease monitoring and implications of therapy. Systematic screening of myositis-specific antibodies, measuring serum biomarker levels, pulmonary function tests, and chest high-resolution computer tomography will be beneficial for the evaluation of disease progression and prognosis.
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Gui X, Li W, Yu Y, Zhao T, Jin Z, Meng K, Wang R, Shi S, Yu M, Ma M, Chen L, Luan W, Xin X, Qiu Y, Qiu X, Zhang Y, Cao M, Cao M, Dai J, Cai H, Huang M, Xiao Y. Prediction model for the pretreatment evaluation of mortality risk in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with interstitial lung disease. Front Immunol 2022; 13:978708. [PMID: 36211445 PMCID: PMC9539924 DOI: 10.3389/fimmu.2022.978708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 09/08/2022] [Indexed: 11/13/2022] Open
Abstract
Background Anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis with interstitial lung disease (anti-MDA5 DM-ILD) is a disease with high mortality. We sought to develop an effective and convenient prediction tool to estimate mortality risk in patients with anti-MDA5 DM-ILD and inform clinical decision-making early. Methods This prognostic study included Asian patients with anti-MDA5 DM-ILD hospitalized at the Nanjing Drum Hospital from December 2016 to December 2020. Candidate laboratory indicators were retrospectively collected. Patients hospitalized from 2016 to 2018 were used as the discovery cohort and applied to identify the optimal predictive features using a least absolute shrinkage and selection operator (LASSO) logistic regression model. A risk score was determined based on these features and used to construct the mortality risk prediction model in combination with clinical characteristics. Results were verified in a temporal validation comprising patients treated between 2019 and 2020. The primary outcome was mortality risk within one year. The secondary outcome was overall survival. The prediction model’s performance was assessed in terms of discrimination, calibration, and clinical usefulness. Results This study included 127 patients, (72 men [56.7%]; median age, 54 years [interquartile range, 48-63 years], split into discovery (n = 87, 70%) and temporal validation (n=37, 30%) cohorts. Five optimal features were selected by LASSO logistic regression in the discovery cohort (n = 87) and used to construct a risk score, including lymphocyte counts, CD3+CD4+ T-cell counts, cytokeratin 19 fragment (CYFRA21-1), oxygenation index, and anti-Ro52 antibody. The retained predictive variables in the final prediction model were age, Heliotrope, fever, and risk score, and the most predictive factor was the risk score. The prediction model showed good discrimination (AUC: 0.915, 95% CI: 0.846–0.957), good calibration (Hosmer–Lemeshow test, P = 0.506; Brier score, 0.12), and fair clinical usefulness in the discovery cohort. The results were verified among patients in the temporal validation cohort (n = 38). We successfully divided patients into three risk groups with very different mortality rates according to the predictive score in both the discovery and validation cohorts (Cochran-Armitage test for trend, P < 0.001). Conclusions We developed and validated a mortality risk prediction tool with good discrimination and calibration for Asian patients with anti-MDA5 DM-ILD. This tool can offer individualized mortality risk estimation and inform clinical decision-making.
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Affiliation(s)
- Xianhua Gui
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Wangzhong Li
- Department of Thoracic Surgery/Oncology, China State Key Laboratory of Respiratory Disease & National Clinical Research Center for Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Center, The State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, China
- Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Sun Yat-Sen University Cancer Center, Guangzhou, China
| | - Yanzhe Yu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Tingting Zhao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Ziyi Jin
- Department of Rheumatology and Immunology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Kaifang Meng
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Rujia Wang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Shenyun Shi
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Min Yu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Miao Ma
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lulu Chen
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Wei Luan
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoyan Xin
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yuying Qiu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaohua Qiu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yingwei Zhang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Min Cao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Mengshu Cao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jinghong Dai
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Hourong Cai
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Mei Huang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Mei Huang, ; Yonglong Xiao,
| | - Yonglong Xiao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
- *Correspondence: Mei Huang, ; Yonglong Xiao,
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Zhou S, Lai J, Wu C, Liu Y, Liu Y, Zhao J, Xu D, Tian X, Li M, Zhao Y, Wang Y, Wang Q, Zeng X. Myocardial involvement is not rare in anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis/clinically amyopathic dermatomyositis: a retrospective study. Front Immunol 2022; 13:928861. [PMID: 35983058 PMCID: PMC9379921 DOI: 10.3389/fimmu.2022.928861] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objectives Studies concerning myocardial involvement (MI) in patients with anti-melanoma differentiation-associated gene 5 antibody-positive dermatomyositis/clinically amyopathic dermatomyositis (anti-MDA5 Ab+ DM/CADM) are scarce. We aimed to characterize MI in our anti-MDA5 Ab+ DM/CADM cohort and to investigate its association with prognosis. Methods In this single-center retrospective study, anti-MDA5 Ab+ hospitalized DM/CADM patients who underwent transthoracic echocardiography (TTE) were enrolled. Myocardial involvement was diagnosed according to abnormal cardiac structure and function detected by TEE. Clinical features and cardiac examination findings of patients with MI were analyzed. Clinical features, laboratory findings, complications, and treatments were compared between MI and non-MI, deceased, and survival patients. Logistic regression analysis was used to explore the independent risk factors for the occurrence of MI and prognostic factors for these patients. Results Seventy-six hospitalized patients with anti-MDA5 Ab+ DM/CADM were enrolled. Twelve (15.8%) patients were diagnosed with MI. Of the 12 patients, three underwent cardiac magnetic resonance imaging (CMR) and late gadolinium enhancement (LGE) were noted for them. TEE revealed that eight (66.7%) patients had left atrial and/or ventricular enlargement, three (25.0%) had cardiac hypertrophy, six (50.0%) had diffuse ventricular wall dyskinesia, and seven (58.3%) had diastolic dysfunction. Six (50.0%) patients with MI developed heart failure (HF) during treatment. Of the 12 patients, one patient died of HF caused by myocarditis, three died of infection, and four died of exacerbation of rapidly progressive interstitial lung disease (RP-ILD). Logistic regression analysis revealed that dysphagia (OR 3.923, 95% CI 1.085, 14.181), NT-proBNP >600 pg/ml (OR 18.333, 95% CI 1.508, 222.875), and increased peripheral white blood cells (OR 1.201, 95% CI 1.003, 1.438) were risk factors for the occurrence of MI, but plasma albumin (OR 0.892, 95% CI 0.796, 0.999) was a protective factor. Both MI (OR 5.984, 95% CI 1.174, 30.496) and RP-ILD (OR 11.875, 95% CI 2.796, 50.411) were independent risk factors for the mortality of these anti-MDA5 Ab+ DM/CADM patients. Conclusion Myocardial involvement is not rare and is an independent poor prognostic factor of anti-MDA5 Ab+ DM/CADM patients. Cardiac abnormality screening is necessary for them.
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Affiliation(s)
- Shuang Zhou
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Jinzhi Lai
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Chanyuan Wu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yongtai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Yingxian Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jiuliang Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Dong Xu
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Xinping Tian
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Mengtao Li
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yan Zhao
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
| | - Yining Wang
- Department of Radiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
- *Correspondence: Qian Wang, ; Yining Wang,
| | - Qian Wang
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
- *Correspondence: Qian Wang, ; Yining Wang,
| | - Xiaofeng Zeng
- Department of Rheumatology and Clinical Immunology, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Dermatologic and Immunologic Diseases (NCRC-DID), Ministry of Science & Technology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital (PUMCH), Key Laboratory of Rheumatology and Clinical Immunology, Ministry of Education, Beijing, China
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The Role of Myositis-Specific Autoantibodies and The Management of Interstitial Lung Disease in Idiopathic Inflammatory Myopathies: A Systematic Review. Semin Arthritis Rheum 2022; 57:152088. [DOI: 10.1016/j.semarthrit.2022.152088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/21/2022] [Accepted: 08/24/2022] [Indexed: 11/24/2022]
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Bobirca A, Alexandru C, Musetescu AE, Bobirca F, Florescu AT, Constantin M, Tebeica T, Florescu A, Isac S, Bojinca M, Ancuta I. Anti-MDA5 Amyopathic Dermatomyositis-A Diagnostic and Therapeutic Challenge. Life (Basel) 2022; 12:1108. [PMID: 35892910 PMCID: PMC9329888 DOI: 10.3390/life12081108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/15/2022] [Accepted: 07/21/2022] [Indexed: 06/15/2023] Open
Abstract
Clinically amyopathic Dermatomyositis (CADM) is a rare subtype of idiopathic inflammatory myositis, associated with no muscular manifestations, which is more frequent in Asian women. Anti-melanoma differentiation-associated gene 5 (MDA5) antibodies are a recently discovered type of specific autoantibodies associated with myositis. The anti-MDA5 DM was initially described in Japan and later it was discovered that the target antigen was a protein implicated in the innate immune response against viruses, that is encoded by the melanoma differentiation-associated gene 5. Anti-MDA5 DM is characteristically associated with distinguished mucocutaneus and systemic manifestations, including skin ulcerations, palmar papules, arthritis, and interstitial-lung disease. Patients with anti-MDA5 positivity have a high risk of developing rapid progressive interstitial-lung disease (RP-ILD), with a poor outcome. As a result, despite high mortality, diagnosis is often delayed, necessitating increased awareness of this possible condition. Despite a severe course of lung disease and an increased mortality rate, there is currently no standard treatment. Recent insights based on observational studies and case reports support combined therapy with immunosuppressive drugs and corticotherapy, as soon as the symptoms appear. The aim of this paper is to describe anti-MDA5 DM, focusing on the recent literature about the unique clinical manifestations and therapeutic options, starting from a severe clinical case diagnosed in our Rheumatology Department.
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Affiliation(s)
- Anca Bobirca
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.B.); (I.A.)
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Cristina Alexandru
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Anca Emanuela Musetescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.M.); (A.F.)
| | - Florin Bobirca
- Department of General Surgery, Carol Davila University of Medicine and Pharmacy, “Dr. Ion Cantacuzino” Clinical Hospital, 050474 Bucharest, Romania
| | - Anca Teodora Florescu
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Magdalena Constantin
- 2nd Department of Dermatology, Colentina Clinical Hospital, “Carol Davila” University of Medicine and Pharmacy, 020125 Bucharest, Romania;
| | - Tiberiu Tebeica
- Department of Histopathology, “Dr. Leventer Centre”, 011216 Bucharest, Romania;
| | - Alesandra Florescu
- Department of Rheumatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.E.M.); (A.F.)
| | - Sebastian Isac
- Department of Physiology and Neuroscience, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Mihai Bojinca
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.B.); (I.A.)
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
| | - Ioan Ancuta
- Department of Internal Medicine and Rheumatology, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.B.); (M.B.); (I.A.)
- Department of Internal Medicine and Rheumatology, “Dr. Ion Cantacuzino” Clinical Hospital, 011437 Bucharest, Romania; (C.A.); (A.T.F.)
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Gono T, Masui K, Sato S, Kuwana M. Mortality Risk Stratification Using Cluster Analysis in Patients With Myositis-Associated Interstitial Lung Disease Receiving Initial Triple-Combination Therapy. Front Med (Lausanne) 2022; 9:883699. [PMID: 35615085 PMCID: PMC9124901 DOI: 10.3389/fmed.2022.883699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/19/2022] [Indexed: 12/04/2022] Open
Abstract
Objective To stratify patients with polymyositis/dermatomyositis-associated interstitial lung disease (ILD) who were initially treated with an intensive regimen consisting of high-dose corticosteroids, a calcineurin inhibitor, and intravenous cyclophosphamide (triple-combo therapy) into subgroups based on mortality outcomes by a cluster analysis using a large-scale multicenter retrospective cohort of Japanese patients with myositis-associated ILD (JAMI). Methods Two-step cluster analysis of preclustering and subsequent hierarchical clustering was conducted in 185 patients who received triple-combo therapy in an unbiased manner. Initial predictors for mortality previously reported in patients with myositis-associated ILD were used as variables and included age, sex, disease duration, classification of myositis, requirement of supplemental oxygen, anti-aminoacyl tRNA synthetase (ARS) antibody, anti-melanoma differentiation-associated gene 5 (MDA5) antibody, and serum levels of C-reactive protein (CRP) and Krebs von den Lungen-6 (KL-6). The cluster model was further applied to 283 patients who received conventional regimens consisting of corticosteroids with or without a single immunosuppressive agent (dual-combo therapy or monotherapy). Cumulative survival rates were compared using Kaplan-Meier analysis, and the log-rank test was used to test for significant differences between two groups. Results We developed a cluster model consisting of 6 clusters, which were categorized by age at onset, clinically amyopathic dermatomyositis, CRP, KL-6, requirement of supplemental oxygen, anti-ARS antibody, and anti-MDA5 antibody. This model was judged to be of good quality based on the silhouette measure of cohesion and separation of 0.6. These clusters were regrouped into three subsets based on low (<10%), moderate (10-50%), and high (>50%) mortality rates. The performance of the clustering was generally replicated in patients who received initial dual-combo therapy or monotherapy. Survival benefits of triple-combo therapy over dual-combo therapy or monotherapy were not observed in any of the clusters. Conclusion We successfully developed a cluster model that stratified patients with myositis-associated ILD who were treated with initial triple-combo therapy into subgroups with different prognoses, although this model failed to identify a patient subgroup that showed survival benefits from triple-combo therapy over dual-combo therapy or monotherapy.
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Affiliation(s)
- Takahisa Gono
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan
| | - Kenichi Masui
- Department of Anaesthesiology, Yokohama City University Hospital, Yokohama, Japan
| | - Shinji Sato
- Division of Rheumatology, Department of Internal Medicine, Tokai University School of Medicine, Isehara, Japan
| | - Masataka Kuwana
- Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
- Scleroderma/Myositis Center of Excellence, Nippon Medical School Hospital, Tokyo, Japan
- *Correspondence: Masataka Kuwana
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Matsuda S, Kotani T, Kuwabara H, Suzuka T, Kiboshi T, Wada Y, Ishida T, Fujiki Y, Shiba H, Hata K, Shoda T, Hirose Y, Takeuchi T. Association of M2 macrophages, Th2, and B cells with pathomechanism in microscopic polyangiitis complicated by interstitial lung disease. J Rheumatol 2022; 49:913-921. [DOI: 10.3899/jrheum.220123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 11/22/2022]
Abstract
Objective To address the pathomechanism of microscopic polyangiitis (MPA) complicated by interstitial lung disease (ILD) using serum biomarker profile and pulmonary histopathology. Methods Serum biomarkers from patients with MPA-ILD (n = 32), MPA without ILD (n = 17), and healthy controls (n =10) were examined. Based on the biomarker profiles, principal component analysis (PCA) and cluster analysis were performed to classify patients with MPA-ILD into subgroups. Clinical characteristics and prognosis were assessed for each subgroup. Two lung biopsies were examined following hematoxylineosin staining and immunostaining. Results T-cell and macrophage polarization was skewed toward the T helper (Th) 2 cells and M2 macrophages in MPA-ILD group relative to that in MPA without ILD group. The PCA allowed classification of the 19 biomarker profiles into three groups: (1) B cell- and neutrophil-related cytokines, vascular angiogenesis-related factors, extracellular matrix-producing factors, (2) Th1-driven cytokines, M1 macrophagedriven cytokines and Th2-driven cytokines, and (3) M2 macrophage -induced and - driven cytokines. The cluster analysis stratified the patients with MPA-ILD into clinically fibrotic dominant (CFD) and clinically inflammatory dominant (CID) groups. Notably, severe infections were significantly higher in the CFD group than in the CID group. Immunohistochemical staining demonstrated intense CXCL13 staining in B cells and Th2 cells in the interstitium of MPA-ILD lungs. Conclusion Activation of M2 macrophages, Th2 cells, and B cells plays a key role in the pathomechanism of MPA-ILD. Classification of MPA-ILD based on serum biomarker profile would be useful in predicting the disease activity and the complication of severe infection in MPA-ILD.
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Jiang D, Xiao H, Dong R, Geng J, Xie B, Ren Y, Dai H. Krebs von den Lungen-6 levels in untreated idiopathic pulmonary fibrosis. THE CLINICAL RESPIRATORY JOURNAL 2022; 16:234-243. [PMID: 35081277 PMCID: PMC9060088 DOI: 10.1111/crj.13475] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/25/2021] [Indexed: 11/28/2022]
Abstract
Background Serum Krebs von den Lungen‐6 (KL‐6) has been reported to be elevated in patients with idiopathic pulmonary fibrosis (IPF). Objective The aim of this study was to evaluate the diagnostic value of KL‐6 and whether the expression value of KL‐6 could indicate the severity of the disease in IPF patients. To address this question, it is necessary to see whether the patients' physical characteristics and other clinical conditions could affect the baseline KL‐6 level. Design We conducted a study of 100 patients who were diagnosed with IPF. Lung function, computed tomography (CT), and serological lab tests data were analyzed. Results The tests showed that there is a significant elevation of KL‐6 in IPF patients compared with other interstitial lung disease (ILD) and healthy controls. It was noted that serum KL‐6 is a stable biomarker not affected by lung infection and smoking, though IPF patients with antinuclear antibody (ANA) showed higher KL‐6 levels. KL‐6, in conjunction with poor pulmonary function and higher radiological fibrosis scores, indicates the severity of the disease but not poor survival. Conclusions It is identified that serum KL‐6 is a useful noninvasive biomarker to help improve the certainty of IPF diagnosis from other interstitial lung disease and assist evaluation of disease severity and prognosis.
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Affiliation(s)
- Dingyuan Jiang
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Beijing, China
| | - Huijuan Xiao
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Beijing, China
| | - Run Dong
- Department of Respiratory Medicine, Capital Medical University, Beijing, China.,Department of Respiratory Medicine, Zhengzhou Central Hospital, Zhengzhou, China
| | - Jing Geng
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Beijing, China
| | - Bingbing Xie
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Beijing, China
| | - Yanhong Ren
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Beijing, China
| | - Huaping Dai
- Department of Pulmonary and Critical Care Medicine, Center of Respiratory Medicine, China-Japan Friendship Hospital, National Clinical Research Center for Respiratory Disease, National Center for Respiratory Medicine, Beijing, China.,Department of Respiratory Medicine, Capital Medical University, Beijing, China
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Tumor markers are associated with rapidly progressive interstitial lung disease in adult-dermatomyositis. Clin Rheumatol 2022; 41:1731-1739. [PMID: 35138465 DOI: 10.1007/s10067-022-06089-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 01/25/2022] [Accepted: 01/31/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES DM-associated rapidly progressive interstitial lung disease (DM-RP-ILD) has been the clinical conundrum. We assess the serum levels of tumor markers (TMs) in different types of ILD, and explore the diagnostic utility of TMs for DM/ADM-RP-ILD. METHODS This was a retrospective cohort study, data including clinical and laboratory records were collected from the first affiliated hospital of Zhengzhou University from December 2015, to June 2020. Tumor markers (TMs) include CEA, CA153, CA724, CA125, and CA199. Spearman analysis, ROC, and Kaplan-Meier curve were used for data analysis. RESULTS Total 272 patients (149 DM and 123 ADM) were enrolled, 152 (55.88%) with ILD (116 with chronic ILD, 36 with RP-ILD) and 120 (44.12%) without ILD among them. The serum levels of CEA and ferritin were significantly higher in patients with RP-ILD than in the other two groups. Serum CA125, CA199, and CA153 levels in patients with RP-ILD were higher than those without ILD. CEA levels were associated with the ferritin, KL-6 and anti-MDA5 levels, and CEA concentration was significantly negatively correlated with DLco (P = 0.016, R2 = - 0.281). CEA [AUC = 0.7, 95% CI = (0.594, 0.806)] and ferritin [AUC = 0.737, 95% CI = (0.614, 0.860)] had diagnosed value for patients developing RP-ILD. Patients with high serum CEA levels had higher mortality rate within the DM-ILD population. CONCLUSIONS TMs and ferritin were increased in DM/ADM-RP-ILD, and serum CEA and CA153 levels can evaluate disease severity of DM. And CEA and ferritin can be used as noninvasive diagnostic biomarkers for patients with DM-RP-ILD. Key Points • Interstitial lung disease (ILD) is a serious complication of DM, and is a leading cause of mortality, especially rapidly progressive ILD. • Tumor markers as a kind of noninvasive detection can reflect the disease severity of DM, and CEA and ferritin can be used to identify patients with RP-ILD.
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OUP accepted manuscript. Rheumatology (Oxford) 2022; 61:e282-e283. [DOI: 10.1093/rheumatology/keac121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 02/09/2022] [Indexed: 11/12/2022] Open
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Zhang T, Shen P, Duan C, Gao L. KL-6 as an Immunological Biomarker Predicts the Severity, Progression, Acute Exacerbation, and Poor Outcomes of Interstitial Lung Disease: A Systematic Review and Meta-Analysis. Front Immunol 2021; 12:745233. [PMID: 34956179 PMCID: PMC8699527 DOI: 10.3389/fimmu.2021.745233] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 11/17/2021] [Indexed: 11/18/2022] Open
Abstract
Object Interstitial lung disease (ILD) is a specific form of chronic fibrosing interstitial pneumonia with various etiology. The severity and progression of ILD usually predict the poor outcomes of ILD. Otherwise, Krebs von den Lungen-6 (KL-6) is a potential immunological biomarker reflecting the severity and progression of ILD. This meta-analysis is to clarify the predictive value of elevated KL-6 levels in ILD. Method EBSCO, PubMed, and Cochrane were systematically searched for articles exploring the prognosis of ILD published between January 1980 and April 2021. The Weighted Mean Difference (WMD) and 95% Confidence Interval (CI) were computed as the effect sizes for comparisons between groups. For the relationship between adverse outcome and elevated KL-6 concentration, Hazard Ratio (HR), and its 95%CI were used to estimate the risk factor of ILD. Result Our result showed that ILD patients in severe and progressive groups had higher KL-6 levels, and the KL-6 level of patients in the severe ILD was 703.41 (U/ml) than in mild ILD. The KL-6 level in progressive ILD group was 325.98 (U/ml) higher than that in the non-progressive ILD group. Secondly, the KL-6 level of patients in acute exacerbation (AE) of ILD was 545.44 (U/ml) higher than stable ILD. Lastly, the higher KL-6 level in ILD patients predicted poor outcomes. The KL-6 level in death of ILD was 383.53 (U/ml) higher than in survivors of ILD. The pooled HR (95%CI) about elevated KL-6 level predicting the mortality of ILD was 2.05 (1.50–2.78), and the HR (95%CI) for progression of ILD was 1.98 (1.07–3.67). Conclusion The elevated KL-6 level indicated more severe, more progressive, and predicted the higher mortality and poor outcomes of ILD.
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Affiliation(s)
- Tao Zhang
- School of Medicine, Zunyi Medical University, Zunyi, China.,Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Ping Shen
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Chunyan Duan
- Medical College, University of Electronic Science and Technology of China, Chengdu, China
| | - Lingyun Gao
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.,Medical College, University of Electronic Science and Technology of China, Chengdu, China
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张 朴, 杨 红, 张 立, 葛 勇, 彭 清, 王 国, 卢 昕. [Value of serum YKL-40 in the diagnosis of anti-MDA5-positive patients with dermatomyositis complicated with severe pulmonary injury]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:1055-1060. [PMID: 34916681 PMCID: PMC8695167 DOI: 10.19723/j.issn.1671-167x.2021.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVE To investigate the value of serum and bronchoalveolar lavage fluid (BALF) chitinase-3-like-1 protein (YKL-40) in the diagnosis of anti-melanoma differentiation-associated gene 5 (MDA5)-positive dermatomyositis (DM) patients complicated with serious pulmonary injury, including rapidly progressive interstitial lung disease (RP-ILD) and pulmonary infection. METHODS Anti-MDA5 antibodies positive patients with DM who were hospitalized in the Department of Rheumatology of China-Japan Friendship Hospital from 2013 to 2018 were involved in this study. Demographic information, clinical, laboratory and imaging data were retrospectively collected. ELISA was used to detect the serum and BALF levels of YKL-40. The receiver operating characteristic (ROC) curve was drawn, and the area under ROC curve (AUC) was used to evaluate the diagnostic value of serum YKL-40 for pulmonary injury.Interstitial lung disease (ILD) was confirmed by chest high-resolution CT (HRCT). RP-ILD was defined as progressive respiratory symptoms such as dyspnea and hypoxemia within 3 months, and/or deterioration of interstitial changes or appearace of new pulmonary interstitial lesions on chest HRCT. Pulmonary infection was considered as positive pathogens detected in qualified sputum, blood, bronchoalveolar lavage fluid or lung biopsy specimens. RESULTS A total of 168 anti-MDA5-positive DM patients including 108 females and 60 males were enrolled in the study. Of these patients, 154 had ILD, and 66(39.3%) of them presented RP-ILD. Seventy patients with pulmonary infection were confirmed by etiology. In the patients with RP-ILD, 39 (59.1%) of them were complicated with pulmonary infection. While only 31 cases(30.4%) had pulmonary infection in the non-RP-ILD patients. The incidence of pulmonary infection in the patients with RP-ILD was significantly higher than that of those with non-RP-ILD (P < 0.001). The serum YKL-40 levels in the RP-ILD patients with pulmonary infection were the highest compared with RP-ILD without pulmonary infection, non-RP-ILD with pulmonary infection and non-RP-ILD without pulmonary infection groups among all the patients [83 (42-142) vs. 42 (21-91) vs. 43 (24-79) vs. 38 (22-69), P < 0.01].The sensitivity, specificity and AUC of serum YKL-40 in the diagnosis of RP-ILD complicated with pulmonary infection were 75%, 67%, and 0.72, respectively. The AUC of diagnosed of anti-MDA5 positive DM patients complicated with RP-ILD and pulmonary infection was higher than that of patients complicated with only RP-ILD and only pulmonary infection (0.72 vs. 0.54 and 0.55, Z=2.10 and 2.11, P < 0.05). CONCLUSION The prognosis of anti-MDA5-positive DM patients with RP-ILD and pulmonary infection were poor. Serum YKL-40 level can be used as a helpful tool for the diagnosis of coexistence of these conditions in the patients.
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Affiliation(s)
- 朴丽 张
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
- 北京大学中日友好临床医学院,北京 100029Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - 红霞 杨
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
- 北京大学中日友好临床医学院,北京 100029Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - 立宁 张
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
- 北京大学中日友好临床医学院,北京 100029Peking University China-Japan Friendship School of Clinical Medicine, Beijing 100029, China
| | - 勇鹏 葛
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 清林 彭
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 国春 王
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
| | - 昕 卢
- 中日友好医院风湿免疫科,北京 100029Department of Rheumatology, China-Japan Friendship Hospital, Beijing 100029, China
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Salinas M, Solomon JJ, Fernández Pérez ER. Connective Tissue Disease-Interstitial Lung Disease-Associated Mortality Rates and Years of Potential Life Lost in the United States. Chest 2021; 160:1368-1371. [PMID: 34625174 DOI: 10.1016/j.chest.2021.03.034] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 03/18/2021] [Accepted: 03/19/2021] [Indexed: 10/20/2022] Open
Affiliation(s)
| | - Joshua J Solomon
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO
| | - Evans R Fernández Pérez
- Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, National Jewish Health, Denver, CO.
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Kim JG, Park Y, Lee J, Ju JH, Kim WU, Park SH, Kwok SK. Re-evaluation of the prognostic significance of oropharyngeal dysphagia in idiopathic inflammatory myopathies. Scand J Rheumatol 2021; 51:402-410. [PMID: 34470549 DOI: 10.1080/03009742.2021.1941243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate the prognostic significance of videofluorographic swallowing study (VFSS)-confirmed oropharyngeal dysphagia in idiopathic inflammatory myopathies (IIMs). METHOD We reviewed the medical records of patients who were diagnosed with IIM between 2009 and 2020 at Seoul St Mary's Hospital. All oropharyngeal dysphagia cases were limited to VFSS-confirmed dysphagia found during the initial diagnostic work-up for IIM. We described the findings on VFSS and the course of the dysphagic symptoms. Logistic regression and survival analyses were performed to evaluate the risk of pneumonia and mortality, respectively. RESULTS We found 88 patients with IIM who met the criteria. Among them, 17 patients (19%) had oropharyngeal dysphagia. Except for two cases lost to follow-up and one deceased case, all of the patients with dysphagia (14 of 14) had swallowing function restored within 6 months. The risk of pneumonia within 3 months from the diagnosis of IIM was significant [odds ratio = 4.49, 95% confidence interval (CI) 1.07-18.88]. The median follow-up duration was 34 and 27 months for the groups without and with dysphagia, respectively. The survival analysis failed to demonstrate that the presence of oropharyngeal dysphagia increased the risk of death (hazard ratio = 0.77, 95% CI: 0.085-7.00). CONCLUSIONS Oropharyngeal dysphagia found at the initial diagnosis of IIM improved within 3-6 months in nearly all cases. Furthermore, IIM patients who had oropharyngeal dysphagia at the initial diagnosis of IIM were not likely to have shorter survival, even if the risk of pneumonia was increased in the short term.
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Affiliation(s)
- J G Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Y Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - J Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - J H Ju
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - W-U Kim
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S-H Park
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - S-K Kwok
- Division of Rheumatology, Department of Internal Medicine, Seoul St Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Gui X, Ma M, Ding J, Shi S, Xin X, Qiu X, Zhang Y, Qiu Y, Cao M, Huang M, Cao M, Dai J, Cai H, Xiao Y. Cytokeratin 19 fragment is associated with severity and poor prognosis of interstitial lung disease in anti-MDA5 antibody-positive dermatomyositis. Rheumatology (Oxford) 2021; 60:3913-3922. [PMID: 33501503 DOI: 10.1093/rheumatology/keaa843] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 10/16/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES In the present study, we aimed to assess the clinical significance of cytokeratin 19 fragment (CYFRA21-1) in patients with anti-melanoma differentiation-associated gene 5 (MDA5) antibody-positive DM-interstitial lung disease (MDA5-DM-ILD). METHODS A total of 73 MDA5-DM-ILD patients were retrospectively analysed in this work. Their clinical characteristics, including clinical manifestations, laboratory findings, peripheral blood lymphocyte subsets and lung function, were compared between patients with acute/subacute interstitial pneumonia (A/SIP) and chronic interstitial pneumonia (CIP). The level of serum CYFRA21-1 was also compared between the above-mentioned two groups of patients, and its association with the clinical features and mortality of MDA5-DM-ILD was also evaluated. RESULTS Of the 73 MDA5-DM-ILD patients, 26 patients exhibited the A/SIP pattern. The level of serum CYFRA21-1 was higher in MDA5-DM patients with A/SIP compared with the CIP group (P = 0.009). Lower oxygenation index (OI), CD3+CD4+ T cell counts and percentage of CD3+CD4+ cells were also observed in MDA5-DM patients with A/SIP compared with the CIP group. Higher serum CYFRA21-1, lower OI, and lower zone consolidation were associated with a higher risk of A/SIP in MDA5-DM-ILD. In addition, 38 decedents with MDA5-DM-ILD exhibited a greater level of CYFRA21-1 compared with 35 survivors (P < 0.001). Furthermore, it was a prognostic factor and also associated with a higher mortality rate (log-rank test, P < 0.001). CONCLUSIONS CYFRA21-1 could be a useful serum indicator associated with occurrence of A/SIP in MDA5-DM-ILD. Moreover, it was associated with a poor survival in MDA5-DM-ILD patients.
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Affiliation(s)
- Xianhua Gui
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Miao Ma
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Jingjing Ding
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - ShenYun Shi
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Xiaoyan Xin
- Department of Radiology, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Xiaohua Qiu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Yingwei Zhang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Yuying Qiu
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Min Cao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Mei Huang
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Mengshu Cao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Jinghong Dai
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Hourong Cai
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
| | - Yonglong Xiao
- Department of Respiratory Medicine, The Affiliated Drum Tower Hospital of Nanjing University Medical School, No. 321 Zhongshan Road, Nanjing 210008, Jiangsu, P. R. China
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Nyborg GA, Molberg Ø. Small intestinal biopsy findings consistent with celiac disease in patients with idiopathic inflammatory myopathy: Review of existing literature. Semin Arthritis Rheum 2021; 51:1033-1044. [PMID: 34416625 DOI: 10.1016/j.semarthrit.2021.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 07/03/2021] [Accepted: 07/21/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Case reports have described patients with idiopathic inflammatory myopathies (IIM) and a concurrent diagnosis of celiac disease (CeD) for whom the muscle inflammation (myositis) component of IIM improves after the patients start standard treatment with gluten-free diet (GFD). A connection between IIM and CeD is not commonly recognized. AIM In this first systematic review of the topic, we aimed to explore all peer-reviewed publications of IIM cases and concomitant small intestinal biopsy findings consistent with CeD, published after 1975. METHODS Systematic literature searches were performed in MEDLINE, PubMed, and EMBASE, supplemented by screening of references and non-systematic searches via Google and Google Scholar. RESULTS Altogether 30 cases published between 1976 and 2017 were uncovered. Information about gastrointestinal symptoms prior to CeD diagnosis was available for 19 patients, with 6/19 (32%) reporting no GI symptoms. CeD-related serological data were available in 23/30 patients. Endomysial antibodies were present in 10/18 (56%), while only 2/9 (22%) had antibodies against tissue transglutaminase. Serum antibodies to native gliadin were present in 16/18 (89%). Clinical effects of a GFD on the IIM were reported for 24 patients, with signs of improvement in 14/24 (58%), including three patients with otherwise therapy-resistant inclusion body myositis. Longitudinal follow-up data available from the published studies indicated that 7/24 (29%) remained in clinical IIM remission with GFD as the sole therapeutic intervention. CONCLUSION In the IIM cases presented here, duodenal biopsy findings consistent with celiac disease was sometimes present without classical CeD symptoms or positive traditional CeD serology, and in the majority of cases, the IIM improved after introduction of a gluten-free diet. While extra vigilance towards CeD in IIM patients seems warranted, there is need for more research to clarify if GFD has effects on organ systems other than the small intestine in patients with IIM and small intestinal biopsy findings consistent with CeD.
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Affiliation(s)
- Gunhild Alvik Nyborg
- Department of Rheumatology, Oslo University Hospital - Rikshospitalet, P.O. box 4950 Nydalen, 0424 Oslo, Norway.
| | - Øyvind Molberg
- Department of Rheumatology, Oslo University Hospital - Rikshospitalet, P.O. box 4950 Nydalen, 0424 Oslo, Norway; Department of Rheumatology and Infectious Diseases, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Ishiwari M, Togashi Y, Takoi H, Kikuchi R, Kawagoe J, Toriyama K, Tanaka A, Nagotomo Y, Kinoshita H, Kono Y, Abe S. Early intervention of plasma exchange combined with intensive immunosuppressive treatment for anti-MDA-5 antibody-positive rapidly progressive interstitial pneumonia: Two case reports. Respir Med Case Rep 2021; 33:101464. [PMID: 34401300 PMCID: PMC8349010 DOI: 10.1016/j.rmcr.2021.101464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/14/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
Background Anti-melanoma differentiation-associated gene 5 antibody (anti-MDA5 Ab) has to be reported to often cause rapidly progressive interstitial lung disease (RP-ILD) especially in East Asian countries. Even with the recommended rapid administration of immunosuppressive agents with high-dose corticosteroids, intravenous pulse cyclophosphamide, and calcineurin inhibitors, the prognosis of anti-MDA5 Ab-related RP-ILD is poor. Plasma exchange (PE) has been reported to be effective for steroid-refractory RP-ILD with anti-MDA5 Ab. However, the timing, frequency, and interval of PE for the treatment of RP-ILD with anti-MDA5 Ab have not yet been established. Case presentation We report two cases of RP-ILD with anti-MDA5 Ab treated by early intervention of PE combined with immunosuppressive treatment. Blood biomarkers including titers of anti-MDA5 Ab, serum KL-6 and ferritin were promptly decreased after each session of PE. Clinical symptoms, oxygenation and chest computed tomography abnormalities were completely improved after immunosuppressive treatment with PE. Conclusion Early intervention of PE combined with immunosuppressive treatment may prevent the development to lethal severe respiratory failure in RP-ILD with anti-MDA5 Ab.
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Affiliation(s)
- Mayuko Ishiwari
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuki Togashi
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hiroyuki Takoi
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Ryota Kikuchi
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Junichiro Kawagoe
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kazutoshi Toriyama
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Akane Tanaka
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yoko Nagotomo
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Hayato Kinoshita
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuta Kono
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
| | - Shinji Abe
- Department of Respiratory Medicine, Tokyo Medical University Hospital, Tokyo, Japan
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He Q, Tang Y, Huang J, Rao Y, Lu Y. The value of KL-6 in the diagnosis and assessment of interstitial lung disease. Am J Transl Res 2021; 13:9216-9223. [PMID: 34540037 PMCID: PMC8430136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 04/12/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To investigate the value of Krebs von den Lungen-6 (KL-6) in the diagnosis and activity assessment of interstitial lung disease (ILD). METHODS The data of 69 ILD patients admitted to our hospital from January 2018 to January 2020 were analyzed retrospectively, and they were included in the ILD group. In addition, 69 patients with connective tissue disease (CTD) admitted to our hospital during the same period were selected and included in the non-ILD (NILD) group. The lung function, pulmonary imaging scores, and KL-6 expression levels were compared between the two groups. The patients in the ILD group were divided into two subgroups: the inactive group and the active group. The pulmonary function, pulmonary imaging scores, and the KL-6 expression levels of the patients in the two subgroups were compared. The value of KL-6 in the diagnosis and the ILD activity evaluation were analyzed. RESULTS The FEV1, FVC, and DLCO levels in the LID group were lower than they were in the NLID group (P<0.05). The LUS and Warrick scores in the LID group were higher than they were in the NLID group (P<0.05). The FEV1, FVC, and DLCO levels in the active group were lower than they were in the inactive group (P<0.05). The LUS and Warrick scores in the active group were higher than they were in the NLID group (P<0.05). The patients' serum KL-6 levels in the ILD group were higher than they were in the NILD group (P<0.05), and the patients' serum KL-6 levels in the ILD group were higher than they were in the inactive group (P<0.05). The Youden's index of serum KL-6 for the diagnosis of ILD was 421.775 U/ml and the sensitivity and specificity of the serum KL-6 were 91.304% and 95.652%, respectively, showing a high diagnostic value (P<0.05). The Youden's index of the serum KL-6 levels for the evaluation of the ILD activity was den Lungen-6 (KL-, with a sensitivity of 60.976% and a specificity of 100%, showing a moderate evaluation value (P<0.05). CONCLUSION KL-6 has a high value in the diagnosis of interstitial lung disease, and a moderate value in the assessment of interstitial lung disease activity.
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Affiliation(s)
- Qiurong He
- West China School of Public Health and West China Fourth Hospital, Sichuan UniversityChengdu, Sichuan, China
| | - Yufan Tang
- West China School of Public Health and West China Fourth Hospital, Sichuan UniversityChengdu, Sichuan, China
| | - Jie Huang
- West China School of Public Health and West China Fourth Hospital, Sichuan UniversityChengdu, Sichuan, China
| | - Yanpin Rao
- West China School of Public Health and West China Fourth Hospital, Sichuan UniversityChengdu, Sichuan, China
| | - Yurun Lu
- Department of Geriatrics, Sichuan Academy of Medical Sciences, Sichuan Provincial People’s HospitalSichuan, China
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Isono T, Nakajima H, Takano K, Kobayashi Y, Kawabata Y, Shimizu Y, Takayanagi N. Slowly progressive interstitial lung disease preceding typical dermatomyositis symptoms in anti-melanoma differentiation-associated gene 5 antibody-positive clinically amyopathic dermatomyositis. Respir Med Case Rep 2021; 34:101491. [PMID: 34381685 PMCID: PMC8339249 DOI: 10.1016/j.rmcr.2021.101491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/22/2021] [Accepted: 07/24/2021] [Indexed: 11/14/2022] Open
Abstract
A 73-year-old woman who visited our hospital complaining of dry cough for three months was refractory to antimicrobial therapy. Chest computed tomography revealed subpleural consolidation. Specimens obtained from surgical lung biopsy revealed subpleural perilobular airspace organization and fibrosis. After the biopsy, mechanic's hand and Gottron's papules appeared, and anti-melanoma differentiation-associated gene 5 (MDA5) antibody was found to be positive. Subsequently, anti-MDA5 antibody measured in cryopreserved serum from her first admission proved to be positive. It is difficult to suspect the presence of anti-MDA-5 antibody in patients with interstitial lung disease without typical dermatomyositis symptoms or slow disease progression.
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Key Words
- ANCA, cytoplasmic autoantibody
- Anti-melanoma differentiation-associated gene 5
- BAL, bronchoalveolar lavage
- CADM, clinically amyopathic dermatomyositis
- CMV, cytomegalovirus
- CT, computed tomography
- Clinically amyopathic dermatomyositis
- DM, dermatomyositis
- HRCT, high-resolution computed tomography
- ILD, interstitial lung disease
- IVCY, intravenous cyclophosphamide
- Interstitial lung disease
- KL-6, Krebs von den Lungen-6
- MDA5, anti-melanoma differentiation-associated gene 5
- PSL, prednisolone
- PaO2, partial pressure of oxygen
- RP-ILD, rapidly progressive interstitial lung disease
- SLB, surgical lung biopsy
- Slowly progressive
- Surgical lung biopsy
- TBLB, transbronchial lung biopsy
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Affiliation(s)
- Taisuke Isono
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Hiromi Nakajima
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Kenji Takano
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Yoichi Kobayashi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Yoshinori Kawabata
- Departments of Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Yoshihiko Shimizu
- Departments of Pathology, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
| | - Noboru Takayanagi
- Department of Respiratory Medicine, Saitama Cardiovascular and Respiratory Center, Saitama, Japan
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Liang J, Cao H, Liu Y, Ye B, Sun Y, Ke Y, He Y, Xu B, Lin J. The lungs were on fire: a pilot study of 18F-FDG PET/CT in idiopathic-inflammatory-myopathy-related interstitial lung disease. Arthritis Res Ther 2021; 23:198. [PMID: 34301306 PMCID: PMC8298695 DOI: 10.1186/s13075-021-02578-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Background Interstitial lung disease (ILD) and its rapid progression (RP) are the main contributors to unfavourable outcomes of patients with idiopathic inflammatory myopathy (IIM). This study aimed to identify the clinical value of PET/CT scans in IIM-ILD patients and to construct a predictive model for RP-ILD. Methods Adult IIM-ILD patients who were hospitalized at four divisions of the First Affiliated Hospital, Zhejiang University School of Medicine (FAHZJU), from 1 January 2017 to 31 December 2020 were reviewed. PET/CT scans and other characteristics of patients who met the inclusion and exclusion criteria were collected and analysed. Results A total of 61 IIM-ILD patients were enrolled in this study. Twenty-one patients (34.4%) developed RP-ILD, and 24 patients (39.3%) died during follow-up. After false discovery rate (FDR) correction, the percent-predicted diffusing capacity of the lung for carbon monoxide (DLCO%, P = 0.014), bilateral lung mean standard uptake value (SUVmean, P = 0.014) and abnormal mediastinal lymph node (P = 0.045) were significantly different between the RP-ILD and non-RP-ILD groups. The subsequent univariate and multivariate logistic regression analyses verified our findings. A “DLM” model was established by including the above three values to predict RP-ILD with a cut-off value of ≥ 2 and an area under the curve (AUC) of 0.905. Higher bilateral lung SUVmean (P = 0.019) and spleen SUVmean (P = 0.011) were observed in IIM-ILD patients who died within 3 months, and a moderate correlation was recognized between the two values. Conclusions Elevated bilateral lung SUVmean, abnormal mediastinal lymph nodes and decreased DLCO% were significantly associated with RP-ILD in IIM-ILD patients. The “DLM” model was valuable in predicting RP-ILD and requires further validation. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02578-9.
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Affiliation(s)
- Junyu Liang
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Heng Cao
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Yinuo Liu
- PET Center, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Bingjue Ye
- Department of Respiratory Diseases, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Yiduo Sun
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Yini Ke
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Ye He
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Bei Xu
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China
| | - Jin Lin
- Department of Rheumatology, The First Affiliated Hospital, Zhejiang University School of Medicine, #79 Qingchun Road, Hangzhou, 310003, Zhejiang Province, People's Republic of China.
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Fujisawa T. Management of Myositis-Associated Interstitial Lung Disease. ACTA ACUST UNITED AC 2021; 57:medicina57040347. [PMID: 33916864 PMCID: PMC8065549 DOI: 10.3390/medicina57040347] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/30/2022]
Abstract
Idiopathic inflammatory myopathies, including polymyositis (PM), dermatomyositis (DM), and clinically amyopathic DM (CADM), are a diverse group of autoimmune diseases characterized by muscular involvement and extramuscular manifestations. Interstitial lung disease (ILD) has major pulmonary involvement and is associated with increased mortality in PM/DM/CADM. The management of PM-/DM-/CADM-associated ILD (PM/DM/CADM-ILD) requires careful evaluation of the disease severity and clinical subtype, including the ILD forms (acute/subacute or chronic), because of the substantial heterogeneity of their clinical courses. Recent studies have highlighted the importance of myositis-specific autoantibodies’ status, especially anti-melanoma differentiation-associated gene 5 (MDA5) and anti-aminoacyl tRNA synthetase (ARS) antibodies, in order to evaluate the clinical phenotypes and treatment of choice for PM/DM/CADM-ILD. Because the presence of the anti-MDA5 antibody is a strong predictor of a worse prognosis, combination treatment with glucocorticoids (GCs) and calcineurin inhibitors (CNIs; tacrolimus (TAC) or cyclosporin A (CsA)) is recommended for patients with anti-MDA5 antibody-positive DM/CADM-ILD. Rapidly progressive DM/CADM-ILD with the anti-MDA5 antibody is the most intractable condition, which requires immediate combined immunosuppressive therapy with GCs, CNIs, and intravenous cyclophosphamide. Additional salvage therapies (rituximab, tofacitinib, and plasma exchange) should be considered for patients with refractory ILD. Patients with anti-ARS antibody-positive ILD respond better to GC treatment, but with frequent recurrence; thus, GCs plus immunosuppressants (TAC, CsA, azathioprine, and mycophenolate mofetil) are often needed in order to achieve favorable long-term disease control. PM/DM/CADM-ILD management is still a therapeutic challenge for clinicians, as evidence-based guidelines do not exist to help with management decisions. A few prospective clinical trials have been recently reported regarding the treatment of PM/DM/CADM-ILD. Here, the current knowledge on the pharmacologic managements of PM/DM/CADM-ILD was mainly reviewed.
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Affiliation(s)
- Tomoyuki Fujisawa
- Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku, Hamamatsu 431-3192, Japan
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Residual Lung Function Impairment Is Associated with Hyperventilation in Patients Recovered from Hospitalised COVID-19: A Cross-Sectional Study. J Clin Med 2021; 10:jcm10051036. [PMID: 33802359 PMCID: PMC7959299 DOI: 10.3390/jcm10051036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/22/2021] [Accepted: 02/23/2021] [Indexed: 11/16/2022] Open
Abstract
Patients who have recovered from COVID-19 show persistent symptoms and lung function alterations with a restrictive ventilatory pattern. Few data are available evaluating an extended period of COVID-19 clinical progression. The RESPICOVID study has been designed to evaluate patients’ pulmonary damage previously hospitalised for interstitial pneumonia due to COVID-19. We focused on the arterial blood gas (ABG) analysis variables due to the initial observation that some patients had hypocapnia (arterial partial carbon dioxide pressure-PaCO2 ≤ 35 mmHg). Therefore, we aimed to characterise patients with hypocapnia compared to patients with normocapnia (PaCO2 > 35 mmHg). Data concerning demographic and anthropometric variables, clinical symptoms, hospitalisation, lung function and gas-analysis were collected. Our study comprised 81 patients, of whom 19 (24%) had hypocapnia as compared to the remaining (n = 62, 76%), and defined by lower levels of PaCO2, serum bicarbonate (HCO3−), carbon monoxide diffusion capacity (DLCO), and carbon monoxide transfer coefficient (KCO) with an increased level of pH and arterial partial oxygen pressure (PaO2). KCO was directly correlated with PaCO2 and inversely with pH. In our preliminary report, hypocapnia is associated with a residual lung function impairment in diffusing capacity. We focus on ABG analysis’s informativeness in the follow-up of post-COVID patients.
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Gono T, Masui K, Nishina N, Kawaguchi Y, Kawakami A, Ikeda K, Kirino Y, Sugiyama Y, Tanino Y, Nunokawa T, Kaneko Y, Sato S, Asakawa K, Ukichi T, Kaieda S, Naniwa T, Okano Y, Kuwana M. Risk Prediction Modeling Based on a Combination of Initial Serum Biomarker Levels in Polymyositis/Dermatomyositis-Associated Interstitial Lung Disease. Arthritis Rheumatol 2021; 73:677-686. [PMID: 33118321 DOI: 10.1002/art.41566] [Citation(s) in RCA: 54] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To establish predictive models for mortality in patients with polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD) using a combination of initial serum biomarker levels. METHODS The Multicenter Retrospective Cohort of Japanese Patients with Myositis-Associated ILD (JAMI) database of 497 incident cases of PM/DM-ILD was used as a derivation cohort, and 111 cases were additionally collected as a validation cohort. Risk factors predictive of all-cause mortality were identified by univariate and multivariable Cox regression analyses using candidate serum biomarkers as explanatory variables. The predictive models for mortality were generated in patients with and those without anti-melanoma differentiation-associated gene 5 (MDA-5) antibody, using a combination of risk factors. Cumulative survival rates were assessed using Kaplan-Meier analysis, and were compared between subgroups using the Breslow test. RESULTS In the derivation cohort, C-reactive protein (CRP) and Krebs von den Lungen 6 (KL-6) levels were identified as independent risk factors for mortality in both anti-MDA-5-positive and anti-MDA-5-negative patients. We then developed a prediction model based on anti-MDA-5 antibody status, CRP level, and KL-6 level, termed the "MCK model," to identify patients at low (<15%), moderate (15-50%), or high (≥50%) risk of mortality, based on the number of risk factors. The MCK model successfully differentiated cumulative survival rates in anti-MDA-5-positive patients (P < 0.01 for low versus moderate risk and P = 0.03 for moderate versus high risk) and in anti-MDA-5-negative patients (P < 0.001 for low versus moderate risk). The utility of the MCK model was replicated in the validation cohort. CONCLUSION Our findings indicate that an evidence-based risk prediction model using CRP and KL-6 levels combined with anti-MDA-5 antibody status might be useful for predicting prognosis in patients with PM/DM-ILD.
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Affiliation(s)
- Takahisa Gono
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Kenichi Masui
- National Defense Medical College School of Medicine, Saitama, Japan, and, Show University Hospital, Tokyo, Japan
| | | | | | - Atsushi Kawakami
- Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kei Ikeda
- Chiba University Hospital, Chiba, Japan
| | - Yohei Kirino
- Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | | | - Yoshinori Tanino
- Fukushima Medical University School of Medicine, Fukushima, Japan
| | | | - Yuko Kaneko
- Keio University School of Medicine, Tokyo, Japan
| | - Shinji Sato
- Tokai University School of Medicine, Kanagawa, Japan
| | | | - Taro Ukichi
- The Jikei University School of Medicine, Tokyo, Japan
| | | | - Taio Naniwa
- Nagoya City University School of Medicine, Aichi, Japan
| | | | - Masataka Kuwana
- Nippon Medical School Graduate School of Medicine, Tokyo, Japan
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Yang Q, Li T, Zhang X, Lyu K, Wu S, Chen Y, Liu S, Yu Z. Initial predictors for short-term prognosis in anti-melanoma differentiation-associated protein-5 positive patients. Orphanet J Rare Dis 2021; 16:58. [PMID: 33516242 PMCID: PMC7847582 DOI: 10.1186/s13023-021-01705-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 01/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Anti-melanoma differentiation-associated protein-5 (anti-MDA5) positive patients are characterized by the high mortality rate caused by interstitial lung disease (ILD). We conducted a retrospective study to summarize the clinical features and identify the initial predictors for death in anti-MDA5 positive patients. Methods We designed a retrospective cohort of anti-MDA5 positive patients. The demographic and clinical data recorded on first admission, as well as the outcomes during the first six months follow-up, were collected. Predictors of rapidly progressive ILD (RPILD) and poor outcomes were calculated using logistic regression models and Cox proportional hazard regression models, respectively. Results A total of 90 anti-MDA5 positive patients were included in this study. Eighty-one (90%) patients presented ILD on admission and 35 (38.9%) patients developed RPILD subsequently. During the first six months of follow-up, 22 (24.4%) patients died of respiratory failure at an average time of 6.6 ± 5.9 weeks. Factors including disease duration < 2 months (OR 6.1, 95% CI 1.7–22.4, P = 0.007), serum ferritin ≥ 1500 ng/ml (OR 12.3, 95% CI 3.1–49.6, P < 0.001), CRP ≥ 13 mg/L (OR 4.6, 95% CI 1.3–16.9, P = 0.021) and total GGO score ≥ 4 (OR 6.3, 95% CI 1.8–21.9, P = 0.003), were identified as independent predictors for RPILD. Cox regression model showed that total CT GGO score ≥ 4 (HR 4.8, 95% CI 1.3–17.9, P = 0.020), KL-6 > 1600 U/ml (HR 3.7, 95% CI 1.5–9.1, P = 0.004) and CRP > 5.8 mg/L (HR 3.7, 95% CI 1.0–12.8, P = 0.044) were poor prognostic risk factors, however initial combined treatment (HR 0.3, 95% CI 0.1–0.8, P = 0.019) predicted good prognosis in anti-MDA5 positive patients. Conclusion Anti-MDA5 positive patients demonstrated a high prevalence of ILD on admission, leading to a high short-term mortality rate. Higher total GGO score, higher levels of initial KL-6 and CRP predict poor outcome in anti-MDA5 positive patients. However, initial intensive treatment may improve the prognosis.
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Affiliation(s)
- Qihua Yang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Tianfang Li
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Xin Zhang
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Kunlong Lyu
- Department of Urology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Shujun Wu
- Department of Respiratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Yan Chen
- Department of Radiology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Shengyun Liu
- Department of Rheumatology and Immunology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
| | - Zujiang Yu
- Department of Infection Diseases, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China.
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Fisseler-Eckhoff A, Märker-Hermann E. [Interstitial lung disease associated with connective tissue disease]. DER PATHOLOGE 2021; 42:4-10. [PMID: 33420569 DOI: 10.1007/s00292-020-00902-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/17/2020] [Indexed: 11/30/2022]
Abstract
Interstitial lung disease (ILD) is the most frequent organ manifestation in rheumatic autoimmune disease. Depending on the underlying autoimmune disease, differently pronounced affections of small airways, interstitial parenchyma, and vessels are found. The group of rheumatic autoimmune diseases mainly includes connective tissue diseases (CTDs), also known as collagen vascular diseases, such as rheumatoid arthritis (RA), systemic sclerosis, (SSc), systemic lupus erythematosus, primary Sjögren's syndrome, idiopathic inflammatory myositis (IIM), and interstitial pneumonia with autoimmune features (IPAF). Frequency and manifestations of parenchymal lung disorders are described clinically, radiologically, and morphologically in these entities. For the precise diagnosis and for the differentiation between the wide range of parenchymal disorders with known possible cause or with unknown origin, also called unclassifiable or idiopathic interstitial pneumonias (IIPs), high resolution computed tomography (HRCT) findings represent the diagnostic gold standard. A transbronchial biopsy, surgical biopsy, or cryobiopsy will be used in unclassifiable findings to confirm a definitive histological confirmation. A precise diagnosis of these ILDs is crucial since the different pathologies that encompass ILD have different therapeutic options. In this sense, the participation of a pneumologist, rheumatologist, radiologist, and pathologist become essential in the multidisciplinary evolution of ILD.
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Affiliation(s)
- Annette Fisseler-Eckhoff
- Institut für Pathologie und Zytologie, Helios Dr. Horst Schmidt-Kliniken Wiesbaden GmbH, Ludwig Erhard Str. 100, 65199, Wiesbaden, Deutschland.
| | - Elisabeth Märker-Hermann
- Klinik für Rheumatologie, Klinische Immunologie und Nephrologie, Helios Dr. Horst Schmidt-Kliniken Wiesbaden, Wiesbaden, Deutschland
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Li R, Zhu WJ, Wang F, Tang X, Luo F. AST/ALT ratio as a predictor of mortality and exacerbations of PM/DM-ILD in 1 year-a retrospective cohort study with 522 cases. Arthritis Res Ther 2020; 22:202. [PMID: 32950060 PMCID: PMC7502203 DOI: 10.1186/s13075-020-02286-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 08/05/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To assess the associations between aspartate transaminase/alanine transaminase ratio (DRR) and mortality in patients with polymyositis/dermatomyositis-associated interstitial lung disease (PM/DM-ILD). PATIENTS AND METHODS This was a retrospective cohort study, which included 522 patients with PM/DM-ILD whose DRR on admission were tested at West China Hospital of Sichuan University during the period from January 1, 2008, to December 31, 2018. Cox regression models were used to estimate hazard ratios for mortality in four predefined DRR strata (≤ 0.91, 0.91-1.26, 1.26-1.73, and > 1.73), after adjusting for age, sex, DRR stratum, diagnosis, overlap syndrome, hemoglobin, platelet count, white blood cell count, the percentage of neutrophils, neutrophil/lymphocyte ratio, albumin, creatine kinase, uric acid/creatinine ratio, triglycerides, or low-density lipoprotein. RESULTS Higher DRR (> 1.73) was an independent predictor of 1-year mortality in multivariate Cox regression analysis (hazard ratio 3.423, 95% CI 1.481-7.911, p = .004). Patients with higher DRR more often required the use of mechanical ventilation and readmission for acute exacerbation of PM/DM-ILD at 1-year follow-up. CONCLUSION Higher DRR on admission for PM/DM-ILD patients are associated with increased mortality, risk of mechanical ventilation, and hospitalization in 1-year follow-up. This low-cost, easy-to-obtain, rapidly measured biomarker may be useful in the identification of high-risk PM/DM-ILD patients that could benefit from intensive management.
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Affiliation(s)
- Renjiao Li
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Wen-Jun Zhu
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Faping Wang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Xiaoju Tang
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China
| | - Fengming Luo
- Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, Sichuan, China.
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Prognostic evaluation of serum osteopontin in patients with anti-MDA5 antibody-positive dermatomyositis associated interstitial lung disease. Cytokine 2020; 135:155209. [PMID: 32738770 DOI: 10.1016/j.cyto.2020.155209] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 07/10/2020] [Accepted: 07/11/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND The anti-melanoma differentiation-associated gene 5 (anti-MDA5) antibody was significantly associated with dermatomyositis associated with interstitial lung disease (DM-ILD) and poor survival in patients. However, there was no convenient and accurate biomarker can predict the poor prognosis of anti-MDA5 positive DM-ILD. This study aimed to evaluate the clinical significance of osteopontin (OPN) in anti-MDA5 positive DM-ILD patients. METHODS The subjects were 43 patients diagnosed DM-ILD with anti-MDA5 antibody. The clinical data were obtained through a review of patient medical records. The serum samples were collected at the time of initial admission and detected for OPN concentrations and ferritin. In addition, immunohistochemistry analysis for OPN was performed on the lung sections of two patients with DM-ILD and six patients with early-stage lung cancer as normal control. RESULTS The median value of serum OPN in patients with anti-MDA5 positive DM-ILD was 1755.65 pg/ml. Immunohistochemical findings for OPN suggested that the expression of OPN in alveolar epithelial cells and macrophages of anti-MDA5-positive ILD patients was more obvious. Significant correlations between serum OPN and ferritin levels were observed (r = 0.317, P = 0.038). Although OPN and ferritin were both associated with mortality in Univariate Cox hazards analysis, OPN was an independent predictor of the prognosis of DM-ILD rather than ferritin in Multivariate Cox hazards analysis. CONCLUSION OPN can be expressed in lung tissues but also can exist as a secreted form in serum, and serum OPN may be a more valuable prognostic biomarker in DM-ILD patients with anti-MDA5 antibody than the serum ferritin.
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Ng KH, Chen DY, Lin CH, Chao WC, Chen YM, Chen YH, Huang WN, Hsieh TY, Lai KL, Tang KT, Chen HH. Risk of interstitial lung disease in patients with newly diagnosed systemic autoimmune rheumatic disease: A nationwide, population-based cohort study. Semin Arthritis Rheum 2020; 50:840-845. [PMID: 32896697 DOI: 10.1016/j.semarthrit.2020.07.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To assess interstitial lung disease (ILD) risk among patients newly diagnosed with systemic autoimmune rheumatic diseases (SARDs) including rheumatoid arthritis (RA), dermatomyositis (DMtis), polymyositis (PM), systemic sclerosis (SSc), systemic lupus erythematosus (SLE) and primary Sjögren's syndrome (pSS). METHOD Using the 1997-2013 Taiwanese National Health Insurance Research Database, we identified 62,930 newly diagnosed SARD patients from 2001 to 2013. We selected 251,720 individuals without SARD diagnoses who were matched (1:4) with SARD patients by age, sex and year of index date. We compared the incidence rates (IRs) of ILD (consistent diagnosis with ICD-9 code 515, 516.3, 516.8, 516.9 or 517 after a ILD-related radiological or pathological procedure) between the specific SARD subgroups and the corresponding non-SARD comparison groups. Using multivariable Cox regression analyses, we estimated hazard ratios (HRs) with 95% confidence intervals (CIs) of ILD in the various SARD groups compared with comparison groups after adjusting for age, sex and Charlson comorbidity index. RESULTS The IR of ILD was greatest among patients with SSc (1,364 per 105 years), followed by DMtis (1,011 per 105 years), PM (831 per 105 years), pSS (196 per 105 years), RA (109 per 105 years) and SLE (120 per 105 years). Multivariable analyses showed that the risk of ILD was increased among patients with SSc (HR, 172.63), DMtis (HR, 119.61), PM (HR, 84.89), SLE (HR, 32.18), pSS (HR, 17.54), or RA (HR, 8.29). CONCLUSION This population-based, cohort study demonstrates that the risk of ILD is significantly increased in patients with newly diagnosed SARDs.
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Affiliation(s)
- Kooi-Heng Ng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - Der-Yuan Chen
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung 40447, Taiwan; Translational Medicine Laboratory, Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan; Department of Healthcare Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Wen-Cheng Chao
- Department of Critical Care Medicine, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Business Administration, National Changhua University of Education, Changhua, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Ming Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Nan Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; Department of Medical Education, Taichung Veterans General Hospital, Taichung, Taiwan; Program of Business, Feng Chia University, Taichung, Taiwan
| | - Kuo-Lung Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; Graduate Institute of Biomedical Electronics and Bioinformatics, National Taiwan University, Taipei, Taiwan
| | - Kuo-Tung Tang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan
| | - Hsin-Hua Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, No. 1650, Taiwan Boulevard Sect. 4, Taichung 40705, Taiwan; Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan; Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan; Institute of Biomedical Science and Rong-Hsing Research Center for Translational Medicine, National Chung-Hsing University, Taichung, Taiwan.
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Yamaguchi K, Yamaguchi A, Onuki Y, Itai M, Kashiwagi C, Takehara K, Aoki S, Kanaya A, Taguchi K, Umetsu K, Oshima K, Uchida M, Kimura H, Kasahara M, Takemura M, Hara K, Sekiguchi A, Motegi SI, Muro Y, Nakasatomi M, Motohashi R, Sakairi T, Nakagawa J, Hiromura K, Obokata M, Kurabayashi M, Maeno T. Clinical features of dermatomyositis associated with anti-MDA5 antibodies by age. Mod Rheumatol 2020; 31:177-185. [PMID: 32149542 DOI: 10.1080/14397595.2020.1740400] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Anti-melanoma differentiation-associated gene 5 (MDA5) autoantibody-positive and age at onset ≥60 years are poor prognosis factors in polymyositis (PM) and dermatomyositis (DM) associated with interstitial lung disease (ILD) among Japanese patients. However, the influence of age on the clinical features of anti-MDA5 autoantibody-positive patients with DM remains unclear. METHODS We retrospectively examined 40 patients with DM and anti-MDA5 autoantibodies according to age. We compared patients aged <60 and ≥60 years with respect to clinical features including laboratory test findings, high-resolution lung computed tomography data, treatment content, and complications such as infections and prognosis. We also examined clinical features between surviving and deceased patients in the older patient group. RESULTS Of 40 enrolled patients, 13 were classified as old and 27 as young. Older patients had significantly fewer clinical symptoms including arthralgia/arthritis (p < .01), skin ulceration (p = .02), and higher mortality than younger patients (p = .02) complicated with rapidly progressive ILD (RP-ILD), combination immunosuppressive therapy, and strictly controlled infections. CONCLUSION Clinical features and mortality of anti-MDA5 autoantibody-positive DM patients were influenced by age. Patients aged ≥60 years had a worse prognosis, and combination immunosuppressive therapy was often ineffective for RP-ILD in older patients.
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Affiliation(s)
- Koichi Yamaguchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Aya Yamaguchi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yuji Onuki
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Miki Itai
- Department of Respiratory Medicine, Fujioka General Hospital, Fujioka, Japan
| | - Chiharu Kashiwagi
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kazutaka Takehara
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Shuhei Aoki
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Azusa Kanaya
- Division of Rheumatology and Nephrology, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Kohei Taguchi
- Department of Respiratory Medicine, Fujioka General Hospital, Fujioka, Japan
| | - Kazue Umetsu
- Department of Respiratory Medicine, Fujioka General Hospital, Fujioka, Japan
| | - Kazuma Oshima
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Megumi Uchida
- Department of Respiratory Medicine, Fujioka General Hospital, Fujioka, Japan
| | - Hayato Kimura
- Division of Rheumatology and Nephrology, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Morimitsu Kasahara
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masao Takemura
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kenichiro Hara
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Akiko Sekiguchi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Sei-Ichiro Motegi
- Department of Dermatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Yoshinao Muro
- Department of Dermatology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Masao Nakasatomi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Rena Motohashi
- Division of Rheumatology and Nephrology, Japanese Red Cross Maebashi Hospital, Maebashi, Japan
| | - Toru Sakairi
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Junichi Nakagawa
- Department of Respiratory Medicine, Fujioka General Hospital, Fujioka, Japan
| | - Keiju Hiromura
- Department of Nephrology and Rheumatology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Masahiko Kurabayashi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toshitaka Maeno
- Department of Allergy and Respiratory Medicine, Gunma University Graduate School of Medicine, Gunma, Japan
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Abstract
The idiopathic inflammatory myopathies (IIMs), including polymyositis (PM) and dermatomyositis (DM), are autoimmune connective tissue diseases with variable degrees of muscle inflammation and systemic involvement. Interstitial lung disease (ILD) is a common complication of the IIMs and is associated with increased mortality. Many patients with PM/DM have myositis-specific and myositis-associated antibodies (MSA/MAAs) that result in distinct clinical phenotypes. Among these MSAs, anti-aminoacyl-tRNA antibodies and anti-melanoma differentiation factor 5 antibodies have high rates of ILD. Corticosteroids are the mainstay of treatment, although the addition of other immunosuppressive therapy is typically necessary to achieve disease control.
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40
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Takanashi S, Nishina N, Nakazawa M, Kaneko Y, Takeuchi T. Usefulness of serum Krebs von den Lungen-6 for the management of myositis-associated interstitial lung disease. Rheumatology (Oxford) 2020; 58:1034-1039. [PMID: 30624752 DOI: 10.1093/rheumatology/key420] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Revised: 11/21/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify biomarkers for assessing myositis-associated interstitial lung disease (ILD). METHODS We reviewed consecutive patients from our institution who had been newly diagnosed with PM, DM, or clinically amyopathic DM during the years 2002-2017. The patients were divided into two groups according to the presence of ILD, and the ILD group was further subdivided into three groups according to the clinical courses of induction failure, relapse and non-relapse. Baseline and time-course changes in the parameters were compared between groups. RESULTS Among 110 patients enrolled, 75 (68%) had ILD. Baseline serum Krebs von den Lungen-6 (KL-6) was significantly higher in the ILD group than in the non-ILD group (1120 vs 236 U/ml; P < 0.001). In the ILD group consisting of the induction failure cases (n = 3), the relapse group (n = 24) and the non-relapse group (n = 48), baseline serum KL-6 was significantly different between the three groups [1971 vs 1870 vs 935 U/ml, respectively; P = 0.003 (relapse group vs non-relapse group)]. The time-course changes in serum KL-6 revealed that KL-6 significantly increased along with relapse, with the increase of 625 U/ml relevant to relapse. CONCLUSION Serum KL-6 is a useful biomarker for assessing the disease activity of myositis-associated ILD.
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Affiliation(s)
- Satoshi Takanashi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Naoshi Nishina
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Maho Nakazawa
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kaneko
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Tsutomu Takeuchi
- Division of Rheumatology, Department of Internal Medicine, Keio University School of Medicine, Tokyo, Japan
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41
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Jablonski R, Bhorade S, Strek ME, Dematte J. Recognition and Management of Myositis-Associated Rapidly Progressive Interstitial Lung Disease. Chest 2020; 158:252-263. [PMID: 32059958 DOI: 10.1016/j.chest.2020.01.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 01/07/2020] [Accepted: 01/22/2020] [Indexed: 01/30/2023] Open
Abstract
Idiopathic inflammatory myopathies are autoimmune processes that are characterized by skeletal muscle inflammation. The lung is the most commonly involved extramuscular organ, and, when present, pulmonary disease drives morbidity and mortality. A subset of patients can present with rapidly progressive hypoxemic respiratory failure due to myositis-related interstitial lung disease. Confirmatory autoantibody testing requires sending samples to a reference laboratory; thus, diagnosis of rapidly progressive myositis-associated interstitial lung disease relies on a high index of suspicion and careful history and physical examination. Although the cornerstone of therapy for these patients remains multimodality immunosuppression, emerging data support a role for advanced therapies (including extracorporeal membrane oxygenation and lung transplantation) in appropriately selected patients. It is hoped that greater awareness of the clinical features of this syndrome will allow for appropriate diagnosis and treatment of these potentially treatable patients, as well as raise awareness of the need for multicenter collaboration to prospectively study how to manage this complex disease.
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Affiliation(s)
- Renea Jablonski
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL.
| | - Sangeeta Bhorade
- Veracyte, San Francisco, CA; Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Mary E Strek
- Department of Medicine, Section of Pulmonary and Critical Care Medicine, University of Chicago, Chicago, IL
| | - Jane Dematte
- Department of Medicine, Division of Pulmonary and Critical Care, Northwestern University Feinberg School of Medicine, Chicago, IL
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Sugiyama Y, Yoshimi R, Takeno M, Kunishita Y, Kishimoto D, Kamiyama R, Kirino Y, Ohno S, Nakajima H. miR-1 is a novel biomarker for polymyositis/dermatomyositis-associated interstitial lung disease. Mod Rheumatol 2019; 30:878-883. [PMID: 31483179 DOI: 10.1080/14397595.2019.1661584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives: Although intensive immunosuppressive treatment is necessary for the severe cases with polymyositis (PM)/dermatomyositis (DM), the prognostic factors or disease activity indices for PM/DM have not been established. Here we investigated the association between serum microRNA-1 (miR-1) level and clinical course of patients with PM/DM.Methods: We retrospectively reviewed baseline clinical and laboratory findings, treatment regimens and outcomes in patients with PM/DM. The serum samples were collected from PM/DM patients and healthy controls (HC). Serum miR-1 levels were determined by quantitative real-time PCR.Results: Twenty-two patients were recruited. The average serum miR-1 level was significantly higher in the PM/DM as compared to HC (p = .0085) and was decreased by treatment (p = .032). We divided the PM/DM-ILD patients into two groups, high and normal miR-1 groups. Although there were no significant differences in the clinical data and the initial prednisolone (PSL) dose between the two groups, PSL dose at 16 weeks, cumulative PSL dose until 16 weeks, and frequency of serious infections were significantly higher in the high miR-1 group as compared to the normal group (p = .025, .036, and .026, respectively).Conclusion: We propose serum miR-1 as a promising novel biomarker for predicting therapeutic response in PM/DM-ILD.
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Affiliation(s)
- Yumiko Sugiyama
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Ryusuke Yoshimi
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Mitsuhiro Takeno
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Department of Allergy and Rheumatology, Nippon Medical School Graduate School of Medicine, Tokyo, Japan
| | - Yosuke Kunishita
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Daiga Kishimoto
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Reikou Kamiyama
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Yohei Kirino
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Shigeru Ohno
- Center for Rheumatic Diseases, Yokohama City University Medical Center, Yokohama, Japan
| | - Hideaki Nakajima
- Department of Stem Cell and Immune Regulation, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Ye Y, Fu Q, Wang R, Guo Q, Bao C. Serum KL-6 level is a prognostic marker in patients with anti-MDA5 antibody-positive dermatomyositis associated with interstitial lung disease. J Clin Lab Anal 2019; 33:e22978. [PMID: 31301087 PMCID: PMC6805307 DOI: 10.1002/jcla.22978] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/26/2019] [Accepted: 06/26/2019] [Indexed: 12/24/2022] Open
Abstract
Objective This study aimed to investigate the clinical significance of Krebs von den Lungen‐6 (KL‐6) serum levels in patients with anti‐MDA5 antibody‐positive dermatomyositis (anti‐MDA5+ DM) having interstitial lung disease (ILD), especially in the amyopathic DM phenotype. Methods The serum KL‐6 level was measured using a chemiluminescence enzyme immunoassay (CLEIA) in patients with anti‐MDA5+ DM, including clinically amyopathic dermatomyositis (CADM)‐ILD and classic DM‐ILD, and healthy donors. The baseline and post‐treatment serum KL‐6 levels were determined in 39 patients with CADM‐ILD who experienced remission or acute exacerbation. The association between laboratory findings, high‐resolution computed tomography (HRCT) scores, pulmonary function tests (PFTs), and the predictive value of baseline KL‐6 level for death was analyzed. Results The serum KL‐6 levels were significantly higher in patients with CADM‐ILD (1339 ± 1329 U/mL) compared with DM‐ILD (642.3 ± 498.4 U/mL) and healthy donors (162.4 ± 54.01 U/mL). The KL‐6 levels correlated positively with chest HRCT scores, serum lactate dehydrogenase, serum ferritin levels, and PFTs, but not with erythrocyte sedimentation rate. During follow‐up, the post‐treatment serum KL‐6 levels significantly reduced in the remission/stable group, but increased in the acute exacerbation group. Higher levels of ferritin and KL‐6 and HRCT scores were independently associated with poor prognosis. The 1‐year survival rate was significantly lower in patients with high KL‐6 level than in those with low KL‐6 level. Conclusion The serum KL‐6 levels may be a useful marker for predicting and monitoring ILD in Chinese patients with anti‐MDA5+ DM, especially amyopathic DM phenotype.
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Affiliation(s)
- Yan Ye
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qiong Fu
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Ran Wang
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Qiang Guo
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Chunde Bao
- Department of Rheumatology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Shappley C, Paik JJ, Saketkoo LA. Myositis-Related Interstitial Lung Diseases: Diagnostic Features, Treatment, and Complications. CURRENT TREATMENT OPTIONS IN RHEUMATOLOGY 2019; 5:56-83. [PMID: 31984206 DOI: 10.1007/s40674-018-0110-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Courtney Shappley
- Ochsner Advanced Lung Disease Program, Ochsner Hospital Foundation, New Orleans, LA
- Tulane University Section of Pulmonary Medicine and Critical Care, New Orleans, LA
| | - Julie J Paik
- Johns Hopkins Medical Institute, Myositis Program, Baltimore, MD
| | - Lesley Ann Saketkoo
- Tulane University Section of Pulmonary Medicine and Critical Care, New Orleans, LA
- New Orleans Scleroderma and Sarcoidosis Patient Care and Research Center
- University Medical Center Comprehensive Pulmonary Hypertension Center
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45
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Chiba Y. Inference on covariate effect types for treatment effectiveness in a randomized trial with a binary outcome. Clin Trials 2019; 16:237-245. [PMID: 30760066 DOI: 10.1177/1740774519828301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Some randomized clinical trials seek to establish covariate effect types that indicate whether a covariate is predictive and/or prognostic, in addition to endpoint evaluation. Here, for a case with a binary outcome, we propose that the covariate effect type should be assessed in terms of four types of potential responses: activated- (always-), inert- (never-), causative-, and preventive-responder. METHODS We introduce a new concept of covariate effect types differing from the commonly used "prediction" and "prognosis." We summarize the covariate effect types by inspecting the proportions of subjects in each response type in two subgroups of a covariate, and indicate whether the fractions are augmented, depleted, or neutral as one changes the level of the covariate. Although these proportions cannot generally be identified, we can derive the posterior distributions of the proportions by applying a recently developed Bayesian method. On the basis of the distributions, we would say that the covariate is "augmented-causative" if the difference between the proportions of causative-responders (who would respond if they received the treatment but would not if they did not) in two subgroups is positive, rather than that it is predictive. Similarly, we would say that the covariate is "neutral-activated" if the difference in the proportion of activated-responders (who would respond regardless of their randomized treatment assignment) is close to zero, rather than saying that the covariate is not prognostic. We further describe the relationship between our approach and standard subgroup analysis. RESULTS We applied our approach to data from a randomized clinical trial comparing nivolumab and docetaxel for subjects with advanced nonsquamous non-small-cell lung cancer; we assessed the covariate effect type of PD-L1 status, where PD-L1 is a ligand of the programmed death 1 (PD-1) receptor expressed by activated T cells. When the endpoint was the overall response rate, the posterior distributions for the differences between the proportions of subjects in response types in the PD-L1-positive and negative subgroups yielded an expected-a-posteriori estimate of 0.243 (95% credible interval (CI): 0.094, 0.374) for causative-responders and 0.014 (95% CI: -0.087, 0.125) for activated-responders. Thus, PD-L1 status was augmented-causative for nivolumab effectiveness, to an extent of 24.3%, and was neutral-activated. CONCLUSION Our approach characterizes the covariate effect types in terms of the response types, and to what extent. In a randomized clinical trial with a binary outcome, our approach is a potentially valuable addition to standard subgroup or regression analysis.
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Affiliation(s)
- Yasutaka Chiba
- Clinical Research Center, Kinki University Hospital, Osakasayama, Japan
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46
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Lee JS, Lee EY, Ha YJ, Kang EH, Lee YJ, Song YW. Serum KL-6 levels reflect the severity of interstitial lung disease associated with connective tissue disease. Arthritis Res Ther 2019; 21:58. [PMID: 30764869 PMCID: PMC6376648 DOI: 10.1186/s13075-019-1835-9] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 01/23/2019] [Indexed: 01/05/2023] Open
Abstract
Background Biomarkers have been actively investigated to supplement functional and imaging modalities to predict the severity, therapeutic responsiveness, and progression of connective tissue disease-associated interstitial lung disease (CTD-ILD). This study aimed to evaluate Krebs von den Lungen 6 (KL-6) as a potential biomarker reflecting the severity of CTD-ILD as assessed through computed tomography (CT) and pulmonary function test (PFT) parameters. Methods This retrospective study included 549 Korean patients with rheumatoid arthritis, systemic sclerosis, inflammatory myositis, and other CTDs with or without concurrent ILD. Serum KL-6 concentration (U/mL) was measured using the latex-enhanced immunoturbidimetric assay method. CT and PFT results were collected within 1 year of serum collection. A semiquantitative grade of ILD extent was evaluated through CT scan (grade 1, 0–25%; grade 2, 26–50%; grade 3, 51–75%; grade 4, 76–100%). Results CTD-ILD patients (n = 165) had elevated serum KL-6 levels compared to CTD patients without ILD (n = 384) (p < 0.001), and those findings were preserved after adjusting for age, sex, and CTD type. The semiquantitative grade of ILD on CT scan was significantly proportional to the KL-6 level, and the optimal cut-off KL-6 value effectively differentiated each ILD grade. The percent diffusing capacity of the lung for carbon monoxide (DLCO) (p < 0.001) and forced vital capacity (FVC) (p < 0.001) parameters had a moderate, negative correlation with the KL-6 level. Conclusion Serum KL-6 levels were increased in CTD-ILD patients and had a positive correlation with CT grade and a negative correlation with FVC and DLCO. Serum KL-6 levels may reflect CTD-ILD severity. Electronic supplementary material The online version of this article (10.1186/s13075-019-1835-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jeong Seok Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - Eun Young Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea
| | - You-Jung Ha
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Eun Ha Kang
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea
| | - Yeong Wook Song
- Division of Rheumatology, Department of Internal Medicine, Seoul National University College of Medicine, 101, Daehak-ro, Jongno-gu, Seoul, 03080, South Korea.
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Kamiya H, Panlaqui OM, Izumi S, Sozu T. Systematic review and meta-analysis of prognostic factors for idiopathic inflammatory myopathy-associated interstitial lung disease. BMJ Open 2018; 8:e023998. [PMID: 30559160 PMCID: PMC6303632 DOI: 10.1136/bmjopen-2018-023998] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
OBJECTIVE To clarify prognostic factors for idiopathic inflammatory myopathy (IIM)-associated interstitial lung disease (ILD). DESIGN Systematic review and meta-analysis using the Grades of Recommendation, Assessment, Development and Evaluation system. DATA SOURCES Medline, EMBASE and Science Citation Index Expanded were searched through 9 August 2018. ELIGIBILITY CRITERIA FOR SELECTING STUDIES The review includes primary studies addressing all-cause mortality of IIM-associated ILD. Potential prognostic factors were any clinical information related to the outcome. DATA EXTRACTION AND SYNTHESIS Two reviewers extracted relevant data independently and assessed risk of bias using the Quality in Prognostic Studies tool. Meta-analysis was conducted using a random effects model and if inappropriate the results were reported qualitatively. Prognostic factors were determined based on statistically significant results derived from multivariate analysis. RESULTS Of a total of 5892 articles returned, 32 were deemed eligible for analysis and cumulatively, these studies reported 28 potential prognostic factors for all-cause mortality. Each study was subject to certain methodological constraints. The four prognostic factors, which demonstrated statistically significant results on both univariate and multivariate analyses, were as follows: age (MD 5.90, 3.17-8.63/HR 1.06, 1.02-1.10 and 2.31, 1.06-5.06), acute/subacute interstitial pneumonia (A/SIP) (OR 4.85, 2.81-8.37/HR 4.23, 1.69-12.09 and 5.17, 1.94-13.49), percentage of predicted forced vital capacity (%FVC) (OR 0.96, 0.95-0.98/HR 0.96, 0.93-0.99) and anti-Jo-1 antibody (OR 0.35, 0.18-0.71/HR 0.004, 0.00003-0.54) (univariate/multivariate, 95% CI). Other prognostic factors included ground glass opacity/attenuation (GGO/GGA) and extent of radiological abnormality. The quality of the presented evidence was rated as either low or very low. CONCLUSIONS Older age, A/SIP, lower value of %FVC, GGO/GGA and extent of radiological abnormality were demonstrated to predict poor prognosis for IIM-associated ILD while a positive test for anti-Jo-1 antibody indicated better prognosis. However, given the weak evidence they should be interpreted with caution. TRIAL REGISTRATION NUMBER CRD42016036999.
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Affiliation(s)
- Hiroyuki Kamiya
- School of Population and Global Health, University of Western Australia, Perth, Western Australia, Australia
| | - Ogee Mer Panlaqui
- Department of Intensive Care Medicine, Northern Hospital, Epping, Victoria, Australia
| | - Shinyu Izumi
- Department of Respiratory Medicine, National Center for Global Health and Medicine, Tokyo, Japan
| | - Takashi Sozu
- Department of Information and Computer Technology, Faculty of Engineering, Tokyo University of Science, Tokyo, Japan
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Long-term pulmonary outcomes and mortality in idiopathic inflammatory myopathies associated with interstitial lung disease. Clin Rheumatol 2018; 38:803-815. [DOI: 10.1007/s10067-018-4353-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 09/30/2018] [Accepted: 10/26/2018] [Indexed: 01/04/2023]
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